Community Pharmacies and Immunization Services in Nigeria from 1980-2023: A Narrative Review

Research Article | DOI: https://doi.org/10.31579/2688-7517/205

Community Pharmacies and Immunization Services in Nigeria from 1980-2023: A Narrative Review

  • Achi James C 1
  • Ogbonna Brian O 2,3*
  • Adenola Ugochi A 2
  • Anietoh Maureen U 2
  • Okpalamma Okoli N 2

1Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Delta State University, Abraka, Nigeria
2Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University Awka, Anambra State, Nigeria
3Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, David Umahi Federal University of Health Sciences, Uburu, Ebonyi State, Nigeria
4Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, University of Abuja, Nigeria 
5Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Madonna University Elele, River State, Nigeria
6Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmaceutical Sciences, Abia State University, Uturu, Abia State, Nigeria
7Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Anambra State University Igboariam, Nigeria 
 

*Corresponding Author: Ogbonna O Brian, Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Madonna University Elele, River State, Nigeria.

Citation: Achi C James, Ogbonna O Brian, Adenola A Ugochi, Anietoh U Maureen, Okpalamma N Okoli, et al, (2025), Community Pharmacies and Immunization Services in Nigeria from 1980-2023: A Narrative Review, J. Pharmaceutics and Pharmacology Research, 8(1); DOI:10.31579/2688-7517/205

Copyright: © 2025, Ogbonna O Brian. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 19 June 2024 | Accepted: 12 July 2024 | Published: 05 February 2025

Keywords: Ogbonna O Brian, Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, Madonna University Elele, River State, Nigeria.

Abstract

Background: Pharmacists practice in a broad multidisciplinary area including community, hospital, industrial, academia, regulatory and practice where they offer therapeutic interventions on drug and medication efficacy, safety and appropriate regimen. Pharmacists have a key role to play to advance public health through immunization. Pharmacists are well trained and play a huge role in vaccine production, research and development, safety, pharmacovigilance, storage, logistics and distribution. This study presented an overview of Community Pharmacies and immunization services in Nigeria and generated information for intervention, outcomes, and policymaking. This study is an overview of Community Pharmacies and immunization studiesand Services reviewed in Nigeria by adopting a narrative review literature writing style.The study was a retrieved literature search conducted on computerized databases. Search terms were used singly, in combination, and truncation to select and synthesize articles. Only studies carried out in Nigeria and written in the English Language with clear study design from 1980 to 2023 were utilized. The data obtained were subjected to descriptive statistics of frequency, percentage, and comparative assessment using the Oxford and Scottish Benchmarks for Study Standard. A total of 17 articles met the criteria and were used for the study. The highest incidence of the articles selected was studied in south-west10 (58.82%), followed by south-south 4(23.53%), respectively. Nationwide has a distribution of 1(5.88%), and South-east had the same number of articles selected 1(5.88%) respectively, while north-west and north-east had 0(0.00%) article selected. However, the north-central had the highest number 1(5.88%) of articles cited in the north, respectively. No article on Community Pharmacies and immunization services was cited before the year 2000 0(0.00%) while the highest number of studies 8(47.06) was conducted between 2021 and 2023, and 7(41.18%) between 2011 and 2020 respectively. The studies were found to fall within the lower half of the Oxford and Scottish benchmarks for the hierarchy of studies and study standards. 

Conclusion: To maintain and improve coverage, uptake and information dissemination in vaccination and national immunization programs, pharmacists/pharmacies should be involved to contribute to this effort and be prepared to respond to public concerns as part of the scope of pharmacy practice in Nigeria. Most of the studies were predominantly carried out in the western, eastern, and central parts of Nigeria.  Nonrandomized intervention studies were available and cross-sectional descriptive surveys were the leading study design carried out which fell within the lower half of two standard benchmarks (Oxford and Scottish) for the hierarchy of studies. Although, Randomized Control Trials (RCTs), narrative reviews, systematic reviews, and meta-analysis of RCTs of PC studies were still not available in the country.

Introduction

The historical model that medical practitioners diagnose disease and prescribe medicines, while pharmacists’ compound and dispense medicines, continues to be the expectation of many medical doctors and a large part of the general public even though new extended pharmacy roles have been shown to have a significant impact on health care management and health care expenses in the long-term [1].  However, pharmacists are challenged to become key players in optimizing and monitoring medication use and to become advocates for patients [2]. Vaccines are known to stimulate the body's immune system for protection against subsequent exposure to the pathogen or disease while immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine [3]. 

Pharmacists' role in vaccination and immunization currently varies across countries in the world. They are empowered to play active roles in ensuring the safe supply, storage, administration and dispensing of vaccines, legally authorized to organize vaccination activities and campaigns, advocating for immunization as well as the integration of community pharmacies and pharmacists in national policies [4]. In Nigeria, the vaccination schedule is drafted as per the National Program on Immunization (NPI). The vaccines are administered across a wide range of government and private hospitals, yet pharmacies and/or pharmacists are not involved in the administration of vaccines and this has posed a great limitation to the uptake of vaccines. Globally, it is estimated that existing immunization programs prevent over 2–3 million deaths annually that could have resulted from vaccine-preventable diseases (VPDs) and approximately 19.4 million children missed out on basic vaccination [5].

This places a great economic burden on VPDs as millions remain susceptible to potentially deadly VPDs despite effective vaccine availability. Although there is no official restriction limiting community pharmacists from providing immunization services in Nigeria, there have not been any policy directions or law towards the involvement of them into that [6]. This has caused limited acceptance and support by the healthcare system to recognize pharmacists as an integral member of the vaccine workforce. Nevertheless, there have also been pharmacist-led organizations who have been championing the inclusion of pharmacists in the vaccine workforce in Nigeria to resolve vaccine hesitancy. In middle and low-income countries where vaccine services are being offered, there is also diminishing perceived competition threat to other healthcare professionals providing immunization services through greater advocacy and wider coverage [4]. This will help Nigeria also in establishing a greater healthcare delivery workforce for the societal benefits of the country and demonstrate the full potentials of the community pharmacies and the pharmacists' role in immunization programs.

Introduction

The historical model that medical practitioners diagnose disease and prescribe medicines, while pharmacists’ compound and dispense medicines, continues to be the expectation of many medical doctors and a large part of the general public even though new extended pharmacy roles have been shown to have a significant impact on health care management and health care expenses in the long-term [1].  However, pharmacists are challenged to become key players in optimizing and monitoring medication use and to become advocates for patients [2]. Vaccines are known to stimulate the body's immune system for protection against subsequent exposure to the pathogen or disease while immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine [3]. 

Pharmacists' role in vaccination and immunization currently varies across countries in the world. They are empowered to play active roles in ensuring the safe supply, storage, administration and dispensing of vaccines, legally authorized to organize vaccination activities and campaigns, advocating for immunization as well as the integration of community pharmacies and pharmacists in national policies [4]. In Nigeria, the vaccination schedule is drafted as per the National Program on Immunization (NPI). The vaccines are administered across a wide range of government and private hospitals, yet pharmacies and/or pharmacists are not involved in the administration of vaccines and this has posed a great limitation to the uptake of vaccines. Globally, it is estimated that existing immunization programs prevent over 2–3 million deaths annually that could have resulted from vaccine-preventable diseases (VPDs) and approximately 19.4 million children missed out on basic vaccination [5].

This places a great economic burden on VPDs as millions remain susceptible to potentially deadly VPDs despite effective vaccine availability. Although there is no official restriction limiting community pharmacists from providing immunization services in Nigeria, there have not been any policy directions or law towards the involvement of them into that [6]. This has caused limited acceptance and support by the healthcare system to recognize pharmacists as an integral member of the vaccine workforce. Nevertheless, there have also been pharmacist-led organizations who have been championing the inclusion of pharmacists in the vaccine workforce in Nigeria to resolve vaccine hesitancy. In middle and low-income countries where vaccine services are being offered, there is also diminishing perceived competition threat to other healthcare professionals providing immunization services through greater advocacy and wider coverage [4]. This will help Nigeria also in establishing a greater healthcare delivery workforce for the societal benefits of the country and demonstrate the full potentials of the community pharmacies and the pharmacists' role in immunization programs.

methods

Study Area: The study covered Community Pharmacies and immunization services studies carried out in Nigeria.

Review question: What is the extent and nature of Community Pharmacies and immunization services in Nigeria?

Study population and type of studies included: The search was carried out on PubMed and Google Scholar, for all Community Pharmacies and immunization services studies. Manual search was done for studies that met the inclusion criteria. This ensured retrieval of relevant studies while focusing on the study objectives. 

Eligibility criteria: 

• Studies published in English language 

• Peer-reviewed papers were eligible for inclusion 

• Community Pharmacies and immunization services studies conducted in Nigeria irrespective of the region 

• Studies with defined protocol and study design either experimental or non-experimental 

• Studies with no conflict of interest stated 

• Studies that provided other information that may help to understand Community Pharmacies and immunization services 

• Studies with clearly stated and defined research design. 

Ineligibility criteria:

• Studies without a clearly defined period, duration, sample size, and location were discarded 

• Studies with methodological flaws 

• Studies with incomplete data. 

Study design: The study was a narrative overview of Community Pharmacies and immunization services in Nigeria.

Risk of Bias: The included studies were assessed for subjects and sampling selection bias, reporting bias before selection.

Condition and Domain studied: Community Pharmacies and immunization studies and articles that described Community Pharmacies and immunization services activities in Nigeria. 

Data extraction was done in accordance with the standard reporting protocol for narrative reviews [7]

Information source: Search was conducted using Google Scholar and PubMed.

Data items and Summary Measures: The data synthesized were sought for study location, design, sample size, year of publication, inclusion criteria, exclusion criteria, year of publication, study instrument, title of publication. Articles that met the inclusion criteria irrespective of their year of publication were selected.

Context: The study covered Community Pharmacies and immunization services studies carried out in Nigeria.

Articles search process: The graphical illustration in the figure below (Fig.1) shows how the search was conducted.  The related keywords to the title of the study were used for the search. PubMed and Google Scholar were used to search for studies and articles on Community Pharmacies and immunization services in Nigeria published between 1980 and 2023. Additional words found appropriate and relevant to the title and objective of the study were utilized. A total of 250 articles were obtained, 47 came from PubMed and 203 articles from Goggle Scholar. These articles were assessed for eligibility based on the inclusion criteria.

Study period and duration: The study lasted from April to May, 2024 and covered peer-reviewed articles published from January 1980 to December, 2023.

Ethical approval:Ethical approval is not applicable here. However, only studies with ethical approval were included and utilized in the review process.

Data analysis: Data was summarized with descriptive statistics.

Study articles selection process: A total of 250 articles were obtained, 47 came from PubMed and 203 articles from Goggle Scholar. These articles were assessed for eligibility based on the inclusion criteria. Overall, 142 studies that fell outside the scope of Community Pharmacies and immunization services were discarded giving rise to 108 articles. On further screening, 88 articles with invalid and incomplete study designs were eliminated, giving rise to 20 articles, and another 3 articles with incomplete follow-up data which gave rise to 17 studies used for the review.

Data extraction instrument, pilot testing, and data extraction process:

Data Extraction design was adapted from a similar study carried out in Nigeria by Ogbonna et al (2019) [8]. Data was extracted by careful consideration of the articles, elimination of irrelevant or incomplete ones that did not meet the study objective and criteria. The remaining data were analyzed and pilot tested. Five articles were used for the pilot test and they were not included in the study. Further modifications such as the arrangement of the date items logically and designing of the sheet into an appropriate table format were made to obtain the final instrument. The instrument was approved by an independent assessor after critiquing it by applying it to two independent studies before being used for the data collection.
 

Figure 1: Flow Chart of Study Process

Results

 

ReferenceTitleLocationDesign

Year

of publication

Sample sizeInclusionExclusionStudy instrument
[9]
  1. Evaluation of the Participation of Community Pharmacists in Primary Healthcare Services in Nigeria: A Mixed-Method Survey Nigeria
South-westA Descriptive cross-sectional survey2022321Only retail pharmacies with first date of registration as community pharmacists was 2018 or earlier were included.Non retail pharmacies with first date of registration as community pharmacists was 2018 or earlierQuestionnaire, Interview
[10]Community pharmacists, participation in immunization services in cross river state, Nigeria.South-SouthA Descriptive cross-sectional survey201968Registered practicing community pharmacists. Registered practicing non community pharmacists and those not willing to participate.Questionnaire
[11]
  1. Availability, storage, handling and administration of vaccines in community pharmacies: Southwest Nigeria as a case study
South-westA Descriptive cross-sectional survey2023191Community PharmacistNon community PharmacistQuestionnaire 
[12]Knowledge, attitude and participation of community pharmacists in Lagos state, Nigeria towards primary health care (PHC)South- westA Descriptive cross-sectional study2015120Licensed community pharmacists within the research areaPharmacists on other line of practice within and outside the research areaQuestionnaire 
[13]
  1. Community pharmacies as possible centers for routine immunization
South- westA Descriptivecross-sectional study200760Community PharmacistNon community PharmacistQuestionnaire
[14]
  1. Evaluation of community pharmacists’ involvement in public health activities in Nigeria.
South- WestA descriptive cross-sectional survey 2018130Eligible registered community pharmacies and pharmacists who gave their consentEligible registered pharmacies and pharmacist who didn’t give their informed consent Questionnaire
[15]Challenges in providing immunization services amongst community pharmacists in south-south Nigeria: A cross sectional studySouth- southA Descriptive cross-sectional study201968

All the licensed community 

pharmacists that registered the 68 community 

pharmacies empowered legally to carry out 

pharmaceutical services

All the licensed community 

pharmacists that did not register the 68 community 

pharmacies empowered legally to carry out 

pharmaceutical services.

Questionnaire 

[16]

 

Perception, benefits and barriers to community pharmacy vaccination services in Nigeria; a cross-sectional study of two south-western statesSouth-westA Descriptive Cross – sectional survey2020474Registered community pharmacist for that yearNon-Registered community pharmacist for that year Questionnaire 
[17]Engaging Nigerian community pharmacists in public health programs: assessment of their knowledge, attitude and practice in Enugu metropolisSouth-eastA Descriptive cross-sectional survey201540Registration with Pharmacist Council of Nigeria (PCN) and a full or part time pharmacist(s) working in the community pharmacy.Registration with Pharmacist Council of Nigeria (PCN) and not a full or part time pharmacist(s) working in the community pharmacy.Questionnaire 
[18]
  1. Immunization Services: Involvement of Community 
  2. Pharmacies in Lagos State, Nigeria
  1. South-west
  1. A descriptive cross-sectional study
  1. 2016
  1. 203
  1. Registered pharmacies and
  2. Pharmacies located within Lagos state
  1. Non-Registered pharmacies and
  2. Pharmacies not located within Lagos state
  1. Questionnaire
[19]Extensive Analysis of Pharmacists’ Roles and Services towards Vaccine-Preventable Diseases in Bayelsa State, NigeriaSouth-southA descriptive cross-sectional study2021105Registered Pharmacist working in Bayelsa StateRegistered Pharmacist not working in Bayelsa StateQuestionnaire
[20]Pharmacists' knowledge and practice regarding immunization in Ogun State, Southwest, Nigeria South-westA descriptive cross-sectional study2021180

Registered and practicing pharmacist in the research area

 

Registered and practicing pharmacist not in the research areaQuestionnaire
[21]Pharmacists’ Readiness to Receive, Recommend and Administer COVID-19 Vaccines in an African Country: an online multiple-practice settings survey in NigeriaNationwide A descriptive cross-sectional study2021509Registered and practicing Pharmacist Not Registered and practicing Pharmacist

Questionnaire

 

[22]

Community Pharmacists’ Services during the COVID-19 Pandemic

A Case Study of Lagos State, Nigeria

South-westA descriptive cross-sectional study2022240Community pharmacists duly registered with the Pharmacists’ Council of Nigeria and practicing in Lagos state. Pharmacists in other pharmacy practice areas were excluded from the study.Questionnaire
[23]Evaluation of Community Pharmacists' Involvement in Primary Health Care.South-south A descriptive cross-sectional study2002110Community pharmacists duly registered with the Pharmacists’ Council of Nigeria and practicing in Benin cityPharmacists in other pharmacy practice areas were excluded from the studyQuestionnaire
[24]

Knowledge and attitude of community pharmacists towards the 

practice of pharmaceutical public health in north-central Nigeria

North-centralA cross-sectional descriptive study2021105Community pharmacist practicing in the study areaPracticing pharmacist in other settingsQuestionnaire
[25]Provision of Pharmaceutical Care Services by Community and Hospital Pharmacists in Oyo State, NigeriaSouth-westA cross-sectional descriptive study202396Community pharmacists registered with the Pharmacists’ Council of Nigeria (PCN), Oyo State Chapter and hospital pharmacists drawn from the nominal rolls of Oyo State Ministry   of  Health  and   University College   Hospital(UCH),  Ibadan.Non Community pharmacists registered with the Pharmacists’ Council of Nigeria (PCN), Oyo State Chapter and non-hospital pharmacists drawn from the nominal rolls of Oyo State Ministry of  Health  and   University College   Hospital(UCH),  Ibadan.Questionnaire

Table 1: Evidence-based table of the characteristics of studies used

S/nGeopolitical zonesNo of Studies n (%)Study Focus
1North-east0 (0.00) 
2North-west0 (0.00) 
3North central1 (5.88)Knowledge and attitude of community Pharmacists towards immunization services
4South-east1 (5.88)Knowledge and attitude of community Pharmacists towards immunization services
5South-south 4 (23.53)Participation, challenges and roles of community Pharmacists towards immunization services
6South-west10 (58.82)Participation, knowledge, attitude, barriers, perception, benefits towards immunization services, availability, storage and handling of vaccines by community Pharmacists
7Nationwide1 (5.88)Readiness to receive and recommend vaccine in community Pharmacies
 Total17 (100) 

Table 2: Focus on studies on Community Pharmacies and immunization services in Nigeria according to geopolitical zone distribution

S/n Level of evidenceDefinition n (%)
11ASystematic Review of RCTs0(0.00)
21BIndividual RCTs0(0.00)
32ASystematic review of cohort studies0(0.00)
42BIndividual cohort studies, Low quality RCT0(0.00)
52CEcological studies0(0.00)
63ASystematic review of case-control studies0(0.00)
73BIndividual case control studies0(0.00)
84Case series, poor quality cohort, and case-control studies17(100)
 Total 17(100)

Table 3: Assessment of Studies on Community Pharmacies and immunization service in Nigeria based on Oxford Center for Evidence-Based Medicine’s Levels of Evidence from Highest to Lowest [26].

S/n

Study types according to hierarchy

 

n (%)
1Systematic review and Meta-analysis0(0.00)
2Randomized Controlled Trials 0(0.00)
3Nonrandomized intervention studies0(0.00)
4Observational studies 17(100)
5Non-experimental studies 0(0.00)
6Expert opinion 0(0.00)
 Total17(100)

Table 4: Assessment of Community Pharmacies and immunization service studies in Nigeria based on the Scottish Intercollegiate Guidelines Network for hierarchy of Study Type [27].

S/nPeriod of publication of studyNo of Studies n (%)
1≤20000 (0.00)
22001-20102 (11.76)
32011-20207 (41.18)
42021-20238 (47.06)
Total 17 (100)

Table 5: Periodic Distribution of Community Pharmacies and immunization service studies in Nigeria

Discussion

An Overview of Community Pharmacies and immunization services in Nigeria

Pharmacists' role in vaccination and immunization currently varies across countries in the world. They are empowered to play active roles in ensuring the safe supply, storage, administration and dispensing of vaccines, legally authorized to organize vaccination activities and campaigns, advocating for immunization as well as the integration of community pharmacies and pharmacists in national policies [4]. In Nigeria, the vaccination schedule is drafted as per the National Program on Immunization (NPI). The vaccines are administered across a wide range of government and private hospitals, yet pharmacies and/or pharmacists are not involved in the administration of vaccines and this has posed a great limitation to the uptake of vaccines. 

Globally, it is estimated that existing immunization programs prevent over 2–3 million deaths annually that could have resulted from vaccine-preventable diseases (VPDs) and approximately 19.4 million children missed out on basic vaccination [5]. Therefore, in order to maintain and improve coverage, uptake and information dissemination in vaccination and national immunization programs, pharmacists/pharmacies should be involved to contribute to this effort and be prepared to respond to public concerns as part of the scope of pharmacy practice in Nigeria. Above all this new extended model of practice by community Pharmacists in community Pharmacies is at its infancy in Nigeria healthcare system.

Notwithstanding, Over the years, there is no official restriction limiting community pharmacists from providing immunization services in Nigeria, there have not been any policy directions or law towards the involvement of them into that [6]. This has caused limited acceptance and support by the healthcare system to recognize pharmacists as an integral member of the vaccine workforce. 

Nevertheless, there have also been pharmacist-led organizations who have been championing the inclusion of pharmacists in the vaccine workforce in Nigeria to resolve vaccine hesitancy. There have been consistent records from various studies showing that availability, attitude, knowledge, barriers, participation, have great effects on Community Pharmacies/Pharmacists providing an extended role on immunization within the healthcare system as the medical profession, other team players in the health care team and populace perceives it as an encroachment of the community Pharmacies/Pharmacist into their excluded right of direct care to the patient and the pharmacist perceives it as a marginalization of their profession, negative attitude between the healthcare team and pharmacist can result in negative collaborative care and also poor communication and over-expectation from both parties can stand as a big barrier in delivering a good immunization services to the populace and as such the idea of vaccination would be defeated if left unattended [28]. However, Observational studies were the best fit in accessing and analyzing the Community Pharmacies/Pharmacists and immunization services across various variables in Nigeria this corresponds to the distribution of the studies showing a higher incidence of non-experimental studies in the country. This could also be as a result of the relative ease in the conduct of an observational study than experimental studies.

Also, due to the reduced cost, manpower, and time employed for an experimental study. Most of the studies cited in the work were also carried out within the last two decades as shown in table 1 and 5, recording 2(11.76%) within the decade of 2001 to 2010 and the next following decade (2011-2020) recording 7(41.18%) and the present decade (2021-2023) recording 8(47.06%), while the decade of 1980-2000 recording no cited work 0(0.00%). This is largely because the concept of Community Pharmacies and immunization services first evolved from the European countries and it’s been gradually adopted by the Nigerian government when because it gives a better outcome in reaching out to more of the populace through the vaccination process which was introduced within the last 2 decades and it has been gradually adopted by Pharmacist’s domicile in the community practice setting.

Description of the Community Pharmacies and immunization services and the extent and nature of work done in Nigeria 

Table 2 revealed the regional distribution of the articles and the study focus of each region. It showed that the highest number of studies were done in South-west 10(58.82), closely followed by South-south 4(23.53%) respectively, followed by the South-east, North central and Nationwide 1(5.88%) of the country respectively. There was no article cited in the North-west and north-east 0(0.00%). The theme of the works conducted in North-central, South-east, South-west, South-south comprised of the impact of the knowledge, attitude, participation and perception between community Pharmacists and immunization services, while that of the North-west, North-east, and Nationwide focused more on the importance of community Pharmacists and immunization services, knowledge, attitude, readiness and perception of community Pharmacies on immunization services.

Most of the works were done within South-east, South-west, South-south region possibly because the majority of the medical and pharmaceutical schools are domiciled there and besides, it is easier to access your patients directly and deliver immunization services in these regions due to less restriction to female genders as well as moral and societal impediments. The Nationwide studies also provided for comparative analysis between regions, states, and more within the year. The few studies cited in the northern region mainly focused on the readiness of community pharmacist to deliver and recommend good immunization services. Among the Northern region, North-Central posed to have higher works 1(5.88%) carried out as opposed North-east 0(0.00%) and North-west 0(0.00%) respectively.

Description of Community Pharmacies and immunization services and comparisons of the studies to the oxford and Scottish benchmarks for the hierarchy of clinical 

As shown by Table 4 on the hierarchy of studies, observational studies had the only recorded number studies 17(100%). Studies in the hierarchy other than nonrandomized intervention studies, had no record as observational studies presumably were the best fit in accessing and analyzing the collaborative differentials across various variables. Most of the studies cited were surveys carried out using questionnaires as the instrument of study. Although the questionnaires were used directly on the respondents. A few of the studies involved immunization and vaccination but most of them were focused on community Pharmacies/Pharmacists. As portrayed by Table 3 on the Evidence-based Medicine Evidence level, Case series, poor quality cohort, and case-control studies was the only score of 17(100%) while the rest of the study with a 0(0.00%) score. This shows that community Pharmacies and immunization services in Nigeria are still in their infancy. 

There is a need for a revised national policy and strategy in Nigeria on vaccination and immunization programs with the involvement of community pharmacies and/or pharmacists.  Community pharmacy is one of the most accessible and most frequently consulted points of care to the public. Indeed, community pharmacies represent healthcare settings in the community where vaccines can be given to the public as pharmacists play a great role and are very well informed about vaccine product characteristics, manufacturing specificities and complexity, vaccine research and development. This will help accelerate getting a wider vaccination access coverage, establishing a greater healthcare delivery workforce for societal benefits and demonstrate the full potential of the community pharmacies and the pharmacists’ role in immunization programs.

Conclusion

Many of the articles cited were studies carried out on Community Pharmacies and immunization services within the Nigerian healthcare system. Most of all the studies conducted were observational. The distribution of the studies recorded a higher incidence of the study conducted South-east, South-west, South-south as compared to the various other regions. The studies fell short of the Oxford and Scottish benchmarks for the hierarchy of studies showing that the community pharmacies and immunization services activities in Nigeria are at their primary level.

Limitations

The possibility of omission due to search and search terms limitations. Some of the studies cited may have some level of bias that escaped elimination which could have an impact on the outcome of the study. The method of presenting tables and data in the present study was purposively chosen for simplicity and clarity even though they could be better presentation formats.

Conflict of interest

The authors have none to declare. 

Grant/Sponsorship

None

Highlights (Learning Points)

1. No narrative review article was found which reviewed the Community Pharmacies and immunization services in Nigeria over the past four decades. 

2. The study articles on community pharmacies and immunization services cited since 2020 fell below the higher upper half of the Hierarchy of Study Type Standard Benchmark of Oxford and Scottish benchmarks. 

3. Majority of the studies on community Pharmacies and immunization services in Nigeria were carried out in South-east, South-west, South-south regions. 

4. The theme of the works conducted in the South-east, South-west, South-south comprised of the impact community pharmacies knowledge, perception, attitude, Barriers, and participation while that of the nationwide focused more on the importance readiness of community pharmacies/pharmacists towards immunization services. There were no studies in the North-west and north-east, while the North-central focused on knowledge and attitude on immunization services.

5. The present work is a narrative overview of Community Pharmacies and immunization services in Nigeria healthcare services. It reviewed a general overview of the Community pharmacies/pharmacists and Immunization services, revealed the studies conducted on the subject matter, showed the level of the work done, and gave a comparison of the available studies with some standard benchmarks for the hierarchy of study type. It also gave recommendations and provided documented information for intervention.

References

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Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

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Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

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Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

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Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

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Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

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Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

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Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

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Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

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Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

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Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

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Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

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Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

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Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

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Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

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S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

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Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

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George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

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Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

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Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

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Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

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Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

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Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

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Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

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Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

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Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

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Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

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Dr Susan Weiner

My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.

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Lin-Show Chin

My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.

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Sonila Qirko

My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.

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Luiz Sellmann

I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.

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Zhao Jia

Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."

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Thomas Urban

I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.

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Cristina Berriozabal

To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.

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Dr Tewodros Kassahun Tarekegn

"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".

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Dr Shweta Tiwari

I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.

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Dr Farooq Wandroo

Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.

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Dr Anyuta Ivanova

We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.

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Dr David Vinyes

My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.

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Gertraud Teuchert-Noodt

To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina

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Dr Elvira Farina

Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.

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Dr Oleg Golyanovski

Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.

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Dr Farahnaz Fallahian

Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.

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Dr Victor Olagundoye

Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.

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Dr Susan Anne Smith

Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD

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Dr Eric S Nussbaum