Table 1

Summary of challenges encountered by the Expanded Program on Immunization Consortium team with study responses to them

Broad challenges	Specific challenges	Response
Human resource challenge	Limited in-country specialists.	Regional recruitment from the West-African subregion.
Vaccination policy change	Administration of birth vaccine doses before discharge to babies delivered in select government hospitals.	Speedily addressed bottleneck with government authorities.
Logistic challenges	Limited road network. Lack of a functional house address system. Shipping of biosamples to northern collaborators.	Worked with the Medical Research Council unit’s logistic and transport system.
Participant recruitment	Sensitised participants delivering outside the study location. Competing interest with another study at the research site. Early discharges from labour ward pressures.	Commenced recruitment at an additional facility. Set up a roving team. Re-organised staff rota to maximise recruitments.
Host health facility challenges	Space constraints. Neonatal sepsis outbreak.	Built an office complex for research operations. Capacity building for government staff on infection control and newborn resuscitation. Worked with and provided technical assistance to host health facility to tackle an outbreak.
Rumours and misconceptions	Study-related rumours.	Community sensitisation. Prepared communication strategy to address rumours.