1
|
Adegoke AA, Balogun FM. How the COVID-19 pandemic affected infant vaccination trends in rural and urban communities in Ibadan, Nigeria: a cross-sectional study. BMJ Open 2024; 14:e073272. [PMID: 38955367 PMCID: PMC11218026 DOI: 10.1136/bmjopen-2023-073272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES This study compared the infant vaccination trends a year before and a year after the onset of the COVID-19 pandemic in selected urban and rural communities in Ibadan, Nigeria. DESIGN This was a cross-sectional study in which data were extracted from infant vaccination records. SETTING Two rural and three urban vaccination centres in primary health clinics at Ibadan Southeast and Olúyòlé local government areas, respectively. PARTICIPANTS Infant vaccination records 1 year before and 1 year after the onset of the COVID-19 pandemic (March 2019-February 2020 and March 2020-February 2021, respectively). OUTCOME MEASURES Timeliness of vaccination (vaccination taken within 2 weeks of appointment) and vaccination completion according to the Nigerian routine infant vaccination schedule. RESULTS 2000 vaccination records were included in the study (1013 (50.6%) for male infants). 840 (42.0%) of the records were from the rural immunisation clinics. There were 1194 (59.7%) and 806 (40.3%) records from before and after the onset of the COVID-19 pandemic, respectively. Before the pandemic, birth dose vaccines were timelier among infants from urban communities, while vaccines given at 6 weeks were timelier in the rural areas. Following the onset of the pandemic, the rural communities had a higher proportion of infants with timelier and complete vaccination except for the birth dose vaccines. Overall, there was higher vaccination completion before the pandemic, and this was higher in the rural compared with the urban communities both before (54.8% vs 11.7%) and after (23.6% vs 1.0%) the onset of the pandemic. CONCLUSIONS A decline in infant vaccination uptake, timeliness and completion persisted 1 year after the COVID-19 pandemic onset, and urban communities were more affected. More efforts are required to ensure optimal infant vaccination, especially in urban communities, to forestall outbreaks of vaccine-preventable diseases.
Collapse
Affiliation(s)
| | - Folusho Mubowale Balogun
- Institute of Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| |
Collapse
|
2
|
Seymour M, Mase M, Rumints M, Neuendorf N, Newland J, Wuatai N, Bauri M, Morris L, Ilumi S, Toliman P, Kelly-Hanku A. Effect of COVID-19 on Routine Immunization During Health Outreach in Western Province, Papua New Guinea. Asia Pac J Public Health 2024:10105395241240803. [PMID: 38576394 DOI: 10.1177/10105395241240803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- Mikaela Seymour
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Maggy Mase
- Sustainable Development Program, Health, Port Moresby, Papua New Guinea
| | - Maria Rumints
- Sustainable Development Program, Health, Port Moresby, Papua New Guinea
| | - Nalisa Neuendorf
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Jamee Newland
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Niko Wuatai
- Western Province Provincial Health Authority, Daru, Papua New Guinea
| | - Mathias Bauri
- Western Province Provincial Health Authority, Daru, Papua New Guinea
| | - Lucy Morris
- Western Province Provincial Health Authority, Daru, Papua New Guinea
| | - Suli Ilumi
- Western Province Provincial Health Authority, Daru, Papua New Guinea
- Middle Fly District Health, Balimo, Papua New Guinea
| | - Pamela Toliman
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
| | - Angela Kelly-Hanku
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
3
|
Elmi N, Smit L, Wessels T, Zunza M, Rabie H. COVID-19 lockdown effect on healthcare utilization and in-hospital mortality in children under 5 years in Cape Town, South Africa: a cross-sectional study. J Trop Pediatr 2023; 69:fmad035. [PMID: 37830545 PMCID: PMC10570990 DOI: 10.1093/tropej/fmad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND COVID-19 pandemic measures resulted in the de-escalation of non-COVID-19 healthcare provision. METHODS A retrospective cross-sectional study of routinely collected data was done to investigate the effect of COVID-19 policies on the healthcare utilization and mortality of children younger than 5 years in Eastern Cape Town, South Africa. We compared visits to primary and urgent care facilities, hospitalization, in-hospital deaths, and vaccine uptake from 1 January to 31 December 2020 to similar periods in 2018 and 2019. RESULTS During April and May 2020, the most restricted period, visits to primary care facilities declined from 126 049 in 2019 to 77 000 (1.8-fold; p < 0.05). This corresponded with a 1.2-fold reduction in the provision of the first dose of measles vaccine at 6 months compared to 2019. Throughout 2020 there was a 4-fold decline in the number of fully immunized children at 1 year of age (p = 0.84). Emergency room visits fell by 35.7% in 2020 (16 368) compared to 2019 (25 446). Hospital admissions decreased significantly (p < 0.01) in 2020 (9810) compared to 2018 (11 698) and 2019 (10 247). The in-hospital mortality rate increased from 2.3% (96/4163) in 2019 to 3.8% (95/2498) (p < 0.01) in Tygerberg Hospital, where 80% (95/119) of deaths were recorded. Twelve of the 119 (10%) deaths occurred in HIV-positive children (p = <0.01). CONCLUSION Measures instituted during the COVID-19 pandemic disrupted access to healthcare services for children. This resulted in an immediate, and potential future, indirect effect on child morbidity and mortality in Cape Town.
Collapse
Affiliation(s)
- Noradin Elmi
- Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town 8000, South Africa
| | - Liezl Smit
- Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town 8000, South Africa
| | - Thandi Wessels
- Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town 8000, South Africa
| | - Moleen Zunza
- Department of Global Health, Stellenbosch University, Cape Town 8000, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town 8000, South Africa
| |
Collapse
|
4
|
Cooper S, Bicaba F, Tiendrebeogo CO, Bila A, Bicaba A, Druetz T. Vaccination coverage in rural Burkina Faso under the effects of COVID-19: evidence from a panel study in eight districts. BMC Health Serv Res 2023; 23:1016. [PMID: 37735414 PMCID: PMC10512531 DOI: 10.1186/s12913-023-10029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Improving infant immunization completion and promoting equitable vaccination coverage are crucial to reducing global under-5 childhood mortality. Although there have been hypotheses that the impact of the COVID-19 pandemic would decrease the delivery of health services and immunization campaigns in low- and middle-income countries, the available evidence is still inconclusive. We conducted a study in rural Burkina Faso to assess changes in vaccination coverage during the pandemic. A secondary objective was to examine long-term trends in vaccination coverage throughout 2010-2021. METHODS Using a quasi-experimental approach, we conducted three rounds of surveys (2019, 2020, 2021) in rural Burkina Faso that we pooled with two previous rounds of demographic and household surveys (2010, 2015) to assess trends in vaccination coverage. The study population comprised infants aged 0-13 months from a sample of 325 households randomly selected in eight districts (n = 736). We assessed vaccination coverage by directly observing the infants' vaccination booklet. Effects of the pandemic on infant vaccination completion were analyzed using multi-level logistic regression models with random intercepts at the household and district levels. RESULTS A total of 736 child-year observations were included in the analysis. The proportion of children with age-appropriate complete vaccination was 69.76% in 2010, 55.38% in 2015, 50.47% in 2019-2020, and 64.75% in 2021. Analyses assessing changes in age-appropriate full-vaccination coverage before and during the pandemic show a significant increase (OR: 1.8, 95% CI: 1.14-2.85). Our models also confirmed the presence of heterogeneity in full vaccination between health administrative districts. The pandemic could have increased inequities in infant vaccination completion between these districts. The analyses suggest no disruption in age-appropriate full vaccination due to COVID-19. Our findings from our sensitivity analyses to examine trends since 2010 did not show any steady trends. CONCLUSION Our findings in Burkina Faso do not support the predicted detrimental effects of COVID-19 on the immunization schedule for infants in low- and middle-income countries. Analyses comparing 2019 and 2021 show an improvement in age-appropriate full vaccination. Regardless of achieving and sustaining vaccination coverage levels in Burkina Faso, this should remain a priority for health systems and political agendas.
Collapse
Affiliation(s)
- Sarah Cooper
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique, Montreal, QC, Canada
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
- Sciences de la Vie et de la Santé, University Aix-Marseille, Marseille, France
| | - Cheick Oumar Tiendrebeogo
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique, Montreal, QC, Canada
| | - Alice Bila
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada.
- Centre de recherche en santé publique, Montreal, QC, Canada.
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| |
Collapse
|
5
|
Zirimenya L, Zalwango F, Owino EA, Karanja HK, Natukunda A, Nkurunungi G, Bukirwa V, Kiwanuka A, Chibita M, Mogire R, Chi P, Webb E, Kaleebu P, Elliott AM. NIHR Global Health Research Group on Vaccines for vulnerable people in Africa (VAnguard): Concept and Launch event report. NIHR OPEN RESEARCH 2023; 3:35. [PMID: 39144544 PMCID: PMC11323737 DOI: 10.3310/nihropenres.13417.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 08/16/2024]
Abstract
Background Vaccination is an important public health intervention, but not everyone benefits equally. Biological, social and structural factors render some communities vulnerable and unable to secure optimal health benefits from vaccination programmes. This drives health inequity and undermines wider vaccine impact by allowing the persistence of non-immune communities as foci for recurrent disease outbreaks. The NIHR Global Health Research Group on Vaccines for vulnerable people in Africa (VAnguard) aims to understand how biological, social, and structural factors interact to impair vaccine impact in vulnerable African communities. Methods The VAnguard project will be implemented through three thematic work packages (1-3) and four cross-cutting work packages (4-7). Work package 1 will investigate the biological drivers and mechanisms of population differences in vaccine responses. Work package 2 will support the understanding of how structural, social and biological determinants of vaccine response interrelate to determine vaccine impact. Work package 3 will synthesise data and lead analyses to develop, model and test community-based integrated strategies to optimise vaccine access, uptake and effectiveness. Work package 4 will plan and implement field investigations (community survey and qualitative studies (with support of work package 2) to explore structural, social & biological determinants impairing vaccine impact. Work package 5 will collaborate with work packages 1-4, to engage communities in designing interventions that aim to directly optimise vaccine impact through a process of co-learning and co-creation between them and the researchers. Work package 6 will build capacity for, and a culture of, consultative, collaborative multidisciplinary vaccine research in East Africa. Work package 7 will support the overall project management and governance. Following the project inception on the 1 st of September 2022, project launch was held in November 2022. Conclusion Results from this project will contribute to the development of integrated strategies that will optimise vaccine benefits and drive health equity.
Collapse
Affiliation(s)
- Ludoviko Zirimenya
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | | | - Esther A. Owino
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
| | - Henry K. Karanja
- Uganda Virus Research Institute, Entebbe, 49, Uganda
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
| | - Agnes Natukunda
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | - Gyaviira Nkurunungi
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | | | - Achilles Kiwanuka
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | - Monica Chibita
- Journalism, Media & Communication, Uganda Christian University, Mukono, 4, Uganda
| | - Reagan Mogire
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
| | - Primus Chi
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
| | - Emily Webb
- London School of Hygiene & Tropical Medicine, London, UK
| | - Pontiano Kaleebu
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
- Uganda Virus Research Institute, Entebbe, 49, Uganda
| | - Alison M Elliott
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
| | - NIHR VAnguard group
- London School of Hygiene & Tropical Medicine, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, London School of Hygiene and Tropical Medicine, Entebbe, 49, Uganda
- Uganda Virus Research Institute, Entebbe, 49, Uganda
- Clinical Research, KEMRI Wellcome Trust Research Programme, Kilifi, 230, Kenya
- Journalism, Media & Communication, Uganda Christian University, Mukono, 4, Uganda
| |
Collapse
|
6
|
Humble RM, Scott SD, Dubé E, Olson J, MacDonald SE. The impact of the COVID-19 pandemic on parents' perceptions and acceptance of routine childhood vaccination in Canada: A national longitudinal study. Vaccine 2023; 41:407-415. [PMID: 36462954 PMCID: PMC9684123 DOI: 10.1016/j.vaccine.2022.11.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND A decline in routine vaccination was reported by some countries early in the COVID-19 pandemic. In the context of the pandemic, determinants of routine childhood vaccination may have changed. Changes over time in parents' perceptions of routine vaccines and intentions for their children during the pandemic have not been fully explored. Understanding changes provides opportunities to promote routine childhood vaccines and address factors that may compromise parents' acceptance. METHODS We conducted longitudinal analysis of two sequential national surveys during the pandemic (Dec 2020 and Oct/Nov 2021) to assess changes over time in Canadian parents' perceptions of routine childhood vaccines, intentions to vaccinate, access for their children ≤ 17 years, and differences among sociodemographic characteristics. McNemar-Bowker tests were used to determine changes in parents' responses collected at two time points. RESULTS Of the 650 parents in the sample, 25.1% with a child ≤ 6 years and 20.5% with a child 7-17 years perceived that routine childhood vaccines were more important because of the pandemic. Between the two time points, parents' confidence in the safety (72.8% to 80.2%, p <.001) and effectiveness (81.7% to 85.2%, p =.007) of routine vaccines increased, parents were more engaged in vaccine decision-making (73.4% to 79.8%, p =.006), and everyday stress preventing vaccination decreased (78.8% to 68.5%, p <.001). Acceptance of routine vaccines increased (82.9% to 86.5%, p =.021), but more parents were undecided about influenza vaccination (12.6% to 20.3%, p =.002). Compared to parents with 1 child, those with 2 children reported increased vaccination acceptance (82.6% to 87.4%, p =.024). INTERPRETATION Under the spotlight of COVID-19, parents' confidence in routine vaccines, engagement in decision-making, and vaccination acceptance increased. Vaccination providers should support parents' decision-making as they navigate routine childhood vaccine uncertainties. Differences in parents' acceptance of routine and influenza vaccines for their children highlight the need for targeted communication strategies for specific vaccines.
Collapse
Affiliation(s)
- Robin M. Humble
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada,Corresponding author at: Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, 11405-87 Ave, Edmonton, Alberta T6G 1C9, Canada
| | - Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada.
| | - Joanne Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | | |
Collapse
|
7
|
Adilo TM, Endale SZ, Demie TG, Dinka TG. The Impact of COVID-19 on Supplies of Routine Childhood Immunization in Oromia Regional State, Ethiopia: A Mixed Method Study. Risk Manag Healthc Policy 2022; 15:2343-2355. [PMID: 36536936 PMCID: PMC9759002 DOI: 10.2147/rmhp.s386717] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/19/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Globally, national immunization programs are at risk of disruption due to severe health system constraints caused by the ongoing Corona Virus Disease 2019 (COVID-19) pandemic. OBJECTIVE To assess the impact of COVID-19 on the availability of supplies of routine childhood immunization in the Oromia Regional State in Ethiopia. METHODS A health facility-based mixed-methods of study design was conducted. Both quantitative and qualitative data were collected using pre-tested questionnaires and key informant interview question guides, respectively. Descriptive statistics such as frequencies, means, and standard deviations were performed. Binary logistic regression analysis was employed to assess the associations between the COVID-19 pandemic and the availability of vaccine-related supplies at health facilities in study area. The qualitative data were analyzed using a thematic content analysis approach. RESULTS Of the total 448 study participants, 214 (47.8%) reported that COVID-19 has disrupted childhood vaccines availability. A significant proportion of participants agreed with the disruption of BCG (62.1%), OPV (48%), IPV (40.4%), and PENTA (36.9%) vaccine availabilities. These findings were also supported with key informant interviews. Fear of not maintaining physical distance (71.4%) followed by government lockdown (68.1%) and inadequate supply by local providers/suppliers (62.4%) were the most frequently reported likely causes for the observed disruptions. A large proportion of participants (87.7% and 81.7%) reported disruptions in the supply of face masks and hand gloves, respectively. As to the binary logistic regression analysis, the study participants from hospitals were 1.72 (1.01, 2.68; 95% CI) times more likely to report the impacts of COVID-19. CONCLUSION Corona Virus Disease -19 significantly disrupted the availability of supplies of childhood immunization in the Oromia region. The most disrupted vaccines and related supplies were BCG, OPV, IPV, PENTA, facemasks, and hand gloves. An effective vaccine supply management is crucial to prevent disruptions during pandemics such as COVID-19.
Collapse
Affiliation(s)
- Takele Menna Adilo
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Samson Zegeye Endale
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Takele Gezahegn Demie
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Temesgen Geleta Dinka
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
8
|
Falope O, Nyaku MK, O'Rourke C, Hermany LV, Plavchak B, Mauskopf J, Hartley L, Kruk ME. Resilience learning from the COVID-19 pandemic and its relevance for routine immunization programs. Expert Rev Vaccines 2022; 21:1621-1636. [PMID: 36063485 DOI: 10.1080/14760584.2022.2116007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The COVID-19 pandemic represents a threat that has posed a challenge to public health response and threatens immunization programs globally. Despite recommendations to continue routine immunization services, disruptions have been observed to these and mass vaccination campaigns. This may result in setbacks to immunization initiative successes and a rise in cases of vaccine-preventable diseases. AREAS COVERED We conducted a systematic literature review to identify studies globally that described how indicators of health system resilience, defined using the Resilient Health System Framework, enabled routine immunizations to continue during the COVID-19 pandemic. A systematic search was conducted in Embase, Web of Science, PsychInfo, medRxiv, bioRxiv, and the gray literature between 1 January 2020, and 12 November 2021. Information was extracted from the studies identified describing how the specific elements of resiliency (being aware, diverse, self-regulating, integrated, and adaptive) were applied to their routine immunization programs. EXPERT OPINION Our study demonstrates the use of tools that contributed to immunization program resilience during the COVID-19 pandemic in all geographic regions and for countries with different income levels. These tools may help inform preparations for other immunization programs to catch up from the COVID-19 pandemic or mitigate the impact of future threats.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
9
|
Early Impact of SARS-CoV-2 Pandemic on Immunization Services in Nigeria. Vaccines (Basel) 2022; 10:vaccines10071107. [PMID: 35891271 PMCID: PMC9315672 DOI: 10.3390/vaccines10071107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background: By 11 March 2022, there were 450,229,635 coronavirus disease (COVID-19) cases and 6,019,085 deaths globally, with Nigeria reporting 254,637 cases and 3142 deaths. One of the essential healthcare services that have been impacted by the pandemic is routine childhood immunization. According to the 2018 National Demographic and Health Survey, only 31% of children aged 12–23 months were fully vaccinated in Nigeria, and 19% of eligible children in the country had not received any vaccination. A further decline in coverage due to the pandemic can significantly increase the risk of vaccine-preventable-disease outbreaks among children in Nigeria. To mitigate such an occurrence, it is imperative to urgently identify how the pandemic and the response strategies have affected vaccination services, hence, the goal of the study. Methods: The research method was qualitative, including in-depth interviews of healthcare workers and focus group discussions (FGDs) with caregivers of children aged 0–23 months. We selected one state from each of the three zones of Nigeria: northern, central, and southern. Within each state, 10 local government areas and 20 healthcare facilities were purposively selected. In each facility, 10 healthcare workers were invited for interviews. Overall, 517 healthcare workers were interviewed. For the focus group discussion, 30 communities were selected. Within each selected community, six consenting caregivers were included. Overall, 180 caregivers participated. The data were analyzed using thematic inductive content analysis. Results: Three significant impacts that were observed are: difficulties in accessibility to immunization services, declining immunization demand and uptake among caregivers due to varying factors, and erosion of vaccine confidence among both caregivers and healthcare workers. Movement restriction and lockdown had numerous major impacts, such as decreased general healthcare service delivery, increased transportation costs, fewer engagements that promote vaccine uptake, and cessation of mobile vaccination campaigns that target hard-to-reach communities. Moreover, misinformation, conspiracy beliefs about the pandemic and COVID-19 vaccines, and risk perception negatively influenced general vaccine confidence. Conclusion: The results of this early impact study show that immunization was directly affected by the pandemic and provide insights into areas where interventions are needed for recovery.
Collapse
|
10
|
Rodo M, Singh L, Russell N, Singh NS. A mixed methods study to assess the impact of COVID-19 on maternal, newborn, child health and nutrition in fragile and conflict-affected settings. Confl Health 2022; 16:30. [PMID: 35659039 PMCID: PMC9162897 DOI: 10.1186/s13031-022-00465-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The impacts of COVID-19 are unprecedented globally. The pandemic is reversing decades of progress in maternal, newborn, child health and nutrition (MNCHN), especially fragile and conflict-affected settings (FCAS) whose populations were already facing challenges in accessing basic health and nutrition services. This study aimed to investigate the collateral impact of COVID-19 on funding, services and MNCHN outcomes in FCAS, as well as adaptations used in the field to continue activities. METHODS A scoping review of peer-reviewed and grey literature published between 1st March 2020-31st January 2021 was conducted. We analysed 103 publications using a narrative synthesis approach. 39 remote semi-structured key informant interviews with humanitarian actors and donor staff within 12 FCAS were conducted between October 2020 and February 2021. Thematic analysis was undertaken independently by two researchers on interview transcripts and supporting documents provided by key informants, and triangulated with literature review findings. RESULTS Funding for MNCHN has been reduced or suspended with increase in cost of continuing the same activities, and diversion of MNCHN funding to COVID-19 activities. Disruption in supply and demand of interventions was reported across different settings which, despite data evidence still being missing, points towards likely increased maternal and child morbidity and mortality. Some positive adaptations including use of technology and decentralisation of services have been reported, however overall adaptation strategies have been insufficient to equitably meet additional challenges posed by the pandemic, and have not been evaluated for their effectiveness. CONCLUSIONS COVID-19 is further exacerbating negative women's and children's health outcomes in FCAS. Increased funding is urgently required to re-establish MNCHN activities which have been deprioritised or halted. Improved planning to sustain routine health services and enable surge planning for emergencies with focus on the community/service users throughout adaptations is vital for improved MNCHN outcomes in FCAS.
Collapse
Affiliation(s)
- Mariana Rodo
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Singh
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Neha S Singh
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK.
| |
Collapse
|
11
|
Yibeltal K, Tsegaye S, Zelealem H, Worku W, Demissie M, Worku A, Berhane Y. Trends, projection and inequalities in full immunization coverage in Ethiopia: in the period 2000-2019. BMC Pediatr 2022; 22:193. [PMID: 35410186 PMCID: PMC8995890 DOI: 10.1186/s12887-022-03250-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immunization is among the most cost-effective health interventions to improve child survival. However, many countries in sub-Saharan Africa failed to achieve their national and international coverage targets repeatedly. The present study investigated trends of coverage and inequalities in coverage in Ethiopia. METHODS This study used data from five rounds of the Demographic and Health Surveys conducted in Ethiopia in 2000, 2005, 2011, 2016, and 2019. The surveys used a multistage cluster sampling procedure to obtain a nationally and sub-nationally representative data. The outcome variables included in the study were full immunization coverage and inequality. The World Health Organization's Health Equity Assessment Toolkit was used to conduct the inequality analysis. Projections for 2025 were based on smoothed averages generated using the demographic and health survey data from 2000 to 2019. RESULTS The full (basic) immunization coverage in Ethiopia has increased steadily from 14.3% in 2000 to 44.1% in 2019. Based on the average past performance, the immunization coverage is projected to reach 53.6% by 2025, which will be short of the 75% national full (basic) immunization coverage target for the year 2025. Mothers with higher levels of education are more likely to get their children all basic vaccinations than those with lower levels of education. Similarly, the inequality gaps due to wealth and residency are significant; where children in the lowest wealth strata and those living in rural areas remained disadvantaged. CONCLUSION Despite a steady increase in immunization coverage in the past two decades the country is yet to achieve its immunization target. Thus, more efforts are needed to achieve the current and future national immunization targets. A more focused intervention targeting the disadvantaged groups could be an effective strategy to achieve coverage and minimize the inequality gaps in immunization.
Collapse
Affiliation(s)
- Kalkidan Yibeltal
- Department Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
| | - Sitota Tsegaye
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Hasset Zelealem
- Department of Epidemiology, Georgia State University School of Public Health, Atlanta, USA
| | - Walelegn Worku
- Department of Global health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Meaza Demissie
- Department of Global health and Health Policy, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Department Reproductive Health and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| |
Collapse
|
12
|
Supporting Immunization Uptake during a Pandemic, Using Remote Phone Call Intervention among Babies Discharged from a Special Neonatal Care Unit (SNCU) in South India. Vaccines (Basel) 2022; 10:vaccines10040507. [PMID: 35455256 PMCID: PMC9025928 DOI: 10.3390/vaccines10040507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
COVID-19 has impacted children’s immunization rates, putting the lives of children at risk. The present study assesses the impact of phone-call counseling, on immunization uptake during the pandemic. Families of babies discharged from the SNCUs in six government centers in three South Indian states were recruited. Calls were made 10 days after the immunization due date. Missed vaccinees were counseled and followed up on 7 and 15 days. Of 2313 contacted, 2097 completed the survey. Respondents were mostly mothers (88.2%), poor (67.5%), and had secondary level education (37.4%). Vaccinations were missed due to the baby’s poor health (64.1%), COVID-19 related concerns (32.6%), and lack of awareness (16.8%). At the end of the intervention, the immunization uptake increased from 65.2% to 88.2%. Phone-call intervention can safely support immunization and lower the burden on health workers.
Collapse
|
13
|
Babatunde OA, Olatunji MB, Omotajo OR, Ikwunne OI, Babatunde AM, Nihinlola ET, Patrick GF, Dairo DM. Impact of COVID-19 on routine immunization in Oyo State, Nigeria: trend analysis of immunization data in the pre- and post-index case period; 2019-2020. Pan Afr Med J 2022; 41:54. [PMID: 35317483 PMCID: PMC8917464 DOI: 10.11604/pamj.2022.41.54.28575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 12/19/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction the response to COVID-19 pandemic has posed new obstacles to the fragile health system, most especially in the area of vaccination across much of Africa. As the response to the pandemic intensifies through the application of non-pharmacologic interventions as well as enforcement of the lockdowns across African cities, there is a significant risk that more children will miss out on life-saving vaccines that can prevent childhood killer diseases. This study was therefore conducted to look at the impact of the COVID-19 pandemic on routine immunization in Oyo State, Nigeria. Methods we conducted a descriptive secondary analysis of immunization data between July 2019 and August 2020. These data were retrieved from the monitoring and evaluation unit of Oyo State Primary Health Care Board. The data were extracted from the original paper format and entered into Excel sheets. Line graphs were plotted to compare the trends of the coverage rates before and after the index case of the COVID-19 pandemic. Results the average coverage rates for Bacillus Calmette-Guérin (BCG) before and after index case were 85.8% and 82.1% respectively, while it was 63.5% and 60.0% for HBV0. For the co-administered vaccines at 14 weeks, Penta 3, OPV 3, PCV 3 and IPV coverage rates dropped from 76.1%, 75.4%, 75.1% and 73.5% to 72.0%, 71.4%, 72.0% and 71.9% respectively. The average coverage rates for yellow fever and measles dropped sharply from 77.0% and 74.5% and 64.6% and 58.6% respectively. The average drop-out rates for the pre-and post-index case periods were 5.0% and 4.7% respectively. For the planned fixed and outreach sessions, none of the monthly sessions met the target of 100.0% in the post-index case period. Conclusion decreased vaccination coverage for vaccine-preventable diseases could cause parallel outbreaks with COVID-19 and further exacerbate the strain on health systems attempting to end the acute phase of this pandemic. Therefore, as the dramatic second wave unfolds, the Government of Nigeria must take deliberate steps to strike a balance between a fresh lockdown and the imperative of uninterrupted social service. In this wise, it must remain committed to a timely vaccination program.
Collapse
Affiliation(s)
- Olaniyan Akintunde Babatunde
- Oyo State Primary Health Care Board, State Secretariat, Agodi, Ibadan, Oyo State, Nigeria.,Oriire Local Government Health Authority, Ikoyi-Ile, Oyo State, Nigeria
| | | | | | | | | | | | | | - David Magbagbeola Dairo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Oyo State, Nigeria
| |
Collapse
|
14
|
Alhaddad AR, Ahmadnezhad E, Fotouhi A. The vaccination coverage rate in under-five children in Nasiriyah (Iraq) before and during the COVID-19 pandemic. Epidemiol Health 2022; 44:e2022035. [PMID: 35381166 PMCID: PMC9350418 DOI: 10.4178/epih.e2022035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ali Rifaat Alhaddad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ahmadnezhad
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
- Correspondence: Elham Ahmadnezhad National Institute of Health Research (NIHR), Tehran University of Medical Sciences, 70 Bozorgmehr Street, Tehran 1416833481, Iran E-mail:
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
15
|
Moreno-Montoya J, Ballesteros SM, Rojas Sotelo JC, Bocanegra Cervera CL, Barrera-López P, De la Hoz-Valle JA. Impact of the COVID-19 pandemic on routine childhood immunisation in Colombia. Arch Dis Child 2022; 107:e4. [PMID: 34285000 PMCID: PMC8295013 DOI: 10.1136/archdischild-2021-321792] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/28/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the impact of the COVID-19 pandemic on routine childhood vaccination coverage in Colombia by age group, rural/urban residence, state and vaccine type. DESIGN Ecological study of official monthly vaccination records. SETTING Vaccination records from the Colombian Ministry of Health (March-October 2019 and 2020). PARTICIPANTS Aggregated data for Colombian children (<12 months, n=676 153; 12-23 months, n=700 319; and 5 years, n=734 295) participating in the Expanded Program on Immunization. MAIN OUTCOME MEASURES Proportion of eligible population receiving vaccination. RESULTS Vaccination coverage showed an overall decline of approximately 14.4% from 2019 to 2020 (2019 coverage=76.0, 2020 coverage=61.6%). The greatest reduction in proportion vaccinated was observed in children <12 months of age for pneumococcal vaccine (second dose) (2019 coverage=81.4%; 2020 coverage=62.2%; 2019-2020 absolute difference, 19.2%; 95% CI 14.8% to 23.7%). For children aged 12-23 months, the proportion vaccinated for yellow fever declined by 16.4% (12.4% to 20.9%) from 78.3% in 2019 to 61.8% in 2020. Among children 5 years of age, the biggest decrease occurred for the oral polio vaccine (second dose), with a difference of 11.4% (7.1% to 15.7%) between 2019 and 2020 (73.1% and 61.7% for 2019 and 2020). We observed a statistically significant effect on vaccine coverage in rural versus urban areas for children <12 months and 5 years of age. CONCLUSIONS Reduced uptake of immunisations during the COVID-19 pandemic poses a serious risk of vaccine-preventable disease outbreaks. Colombia and other middle-income countries need to continue to monitor immunisation programme coverage and disease outbreaks at the national and subnational levels and undertake catch-up vaccination activities.
Collapse
Affiliation(s)
- Jose Moreno-Montoya
- Clinical Studies and Clinical Epidemiology Division, Hospital Universitario de la Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - Silvia Marcela Ballesteros
- Clinical Studies and Clinical Epidemiology Division, Hospital Universitario de la Fundación Santa Fe de Bogotá, Bogota, Colombia
| | | | | | - Pedro Barrera-López
- Clinical Studies and Clinical Epidemiology Division, Hospital Universitario de la Fundación Santa Fe de Bogotá, Bogota, Colombia
| | - José A De la Hoz-Valle
- Clinical Studies and Clinical Epidemiology Division, Hospital Universitario de la Fundación Santa Fe de Bogotá, Bogota, Colombia
| |
Collapse
|
16
|
Shet A, Carr K, Danovaro-Holliday MC, Sodha SV, Prosperi C, Wunderlich J, Wonodi C, Reynolds HW, Mirza I, Gacic-Dobo M, O'Brien KL, Lindstrand A. Impact of the SARS-CoV-2 pandemic on routine immunisation services: evidence of disruption and recovery from 170 countries and territories. Lancet Glob Health 2022; 10:e186-e194. [PMID: 34951973 PMCID: PMC8691849 DOI: 10.1016/s2214-109x(21)00512-x] [Citation(s) in RCA: 135] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/29/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The SARS-CoV-2 pandemic has revealed the vulnerability of immunisation systems worldwide, although the scale of these disruptions has not been described at a global level. This study aims to assess the impact of COVID-19 on routine immunisation using triangulated data from global, country-based, and individual-reported sources obtained during the pandemic period. METHODS This report synthesised data from 170 countries and territories. Data sources included administered vaccine-dose data from January to December, 2019, and January to December, 2020, WHO regional office reports, and a WHO-led pulse survey administered in April, 2020, and June, 2020. Results were expressed as frequencies and proportions of respondents or reporting countries. Data on vaccine doses administered were weighted by the population of surviving infants per country. FINDINGS A decline in the number of administered doses of diphtheria-pertussis-tetanus-containing vaccine (DTP3) and first dose of measles-containing vaccine (MCV1) in the first half of 2020 was noted. The lowest number of vaccine doses administered was observed in April, 2020, when 33% fewer DTP3 doses were administered globally, ranging from 9% in the WHO African region to 57% in the South-East Asia region. Recovery of vaccinations began by June, 2020, and continued into late 2020. WHO regional offices reported substantial disruption to routine vaccination sessions in April, 2020, related to interrupted vaccination demand and supply, including reduced availability of the health workforce. Pulse survey analysis revealed that 45 (69%) of 65 countries showed disruption in outreach services compared with 27 (44%) of 62 countries with disrupted fixed-post immunisation services. INTERPRETATION The marked magnitude and global scale of immunisation disruption evokes the dangers of vaccine-preventable disease outbreaks in the future. Trends indicating partial resumption of services highlight the urgent need for ongoing assessment of recovery, catch-up vaccination strategy implementation for vulnerable populations, and ensuring vaccine coverage equity and health system resilience. FUNDING US Agency for International Development.
Collapse
Affiliation(s)
- Anita Shet
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Kelly Carr
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Christine Prosperi
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Chizoba Wonodi
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | |
Collapse
|
17
|
Wang R, Jing W, Liu M, Liu J. Trends of the Global, Regional, and National Incidence of Measles, Vaccine Coverage, and Risk Factors in 204 Countries From 1990 to 2019. Front Med (Lausanne) 2022; 8:798031. [PMID: 35127753 PMCID: PMC8810814 DOI: 10.3389/fmed.2021.798031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/14/2021] [Indexed: 12/23/2022] Open
Abstract
BackgroundMeasles is a highly contagious disease that has caused global morbidity and mortality. Though great progress has been made in measles elimination, the resurgence of measles has been observed in recent years. As extant literature were mainly confined to data of local area, we conducted a systematic analysis to explore the trends of the incidence of measles, coverage rate, and the risk factors from 1990 to 2019 on global, regional, and national levels.MethodsData on cases of incidence, age standardized rate (ASR), vaccine coverage, and risk factors of measles were retrieved from the Global Burden of Disease (GBD) Study 2019 database. Estimated averaged percentage change (EAPC) of ASR was calculated to quantify the trends of measles incidence. Pearson correlation was applied to assess the association of EAPC and measles-containing vaccine coverage rate with socio-demographic index (SDI) in 2019, and the correlation between ASR and measles-containing vaccine coverage rate.ResultsGlobally, there was a significant decrease in the number (84.18%) and ASR (6.13%, 95% CI: 5.41–6.84%) of measles incidence from 1990 to 2019. More than 80% of incidence cases were attributed to children under 5 and the proportion was highest in low SDI region. Countries and territories with low ASRs are mostly clustered in North America, Southern Latin America, and Western Europe, whereas those with high ASRs are mainly clustered in Africa, East Asia, and South Asia. Lower SDI was associated with higher ASR and lower vaccine coverage rate. The more the SDI value was further away from 0.6, the smaller the absolute value did EAPC have. Child wasting accounted for the most measles-related death cases, followed by child underweight, child stunting, and vitamin A deficiency.ConclusionsMeasles eradication is feasible, but urgently demands political commitment, financial support, and public engagement. In the context of COVID-19 pandemic and the global resurgence of measles, surveillance systems and routine immunization programs should be improved, while vaccine hesitancy needs to be addressed.
Collapse
Affiliation(s)
- Ruitong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wenzhan Jing
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- *Correspondence: Jue Liu
| |
Collapse
|
18
|
COVID-19 Impact on Disparity in Childhood Immunization in Low- and Middle-Income Countries Through the Lens of Historical Pandemics. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:225-233. [PMID: 36569790 PMCID: PMC9760533 DOI: 10.1007/s40475-022-00273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 12/23/2022]
Abstract
Purpose of Review The COVID-19 pandemic, since 2020, has affected health care services and access globally. Although the entire impact of COVID-19 pandemic on existing global public health is yet to be fully seen, the impact of COVID-19 pandemic on global childhood immunization programs is of particular importance. Recent Findings Disruptions to service delivery due to lockdowns, challenges in vaccination programs, vaccine misinformation and hesitancy, and political and social economic inequalities all posed a threat to existing childhood immunization programs. These potential threats were especially critical in LMIC where childhood immunization programs tend to experience suboptimal implementation. Summary This review provides an overview of childhood immunizations and discusses past pandemics particularly in LMIC, factors contributing to disparities in childhood immunizations, and reviews potential lessons to be learned from past pandemics. Vaccine hesitancy, social determinants of health, and best practices to help lessen the pandemic's influence are also further elaborated. To address current challenges that hindered the progress made in prevention of childhood illnesses through vaccination campaigns and increased vaccine availability, lessons learned through best practices explored from past pandemics must be examined to mitigate impact of COVID-19 on childhood immunization and in turn conserve health and improve economic well-being of children especially in LMIC.
Collapse
|
19
|
Vassallo A, Dunbar K, Ajuwon B, Lowbridge C, Kirk M, King C, Sheel M. Assessing the impact of polio supplementary immunisation activities on routine immunisation and health systems: a systematic review. BMJ Glob Health 2021; 6:bmjgh-2021-006568. [PMID: 34776411 PMCID: PMC8593720 DOI: 10.1136/bmjgh-2021-006568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction The Global Polio Eradication Initiative uses polio supplementary immunisation activities (SIAs) as a strategy to increase vaccine coverage and cease poliovirus transmission. Impact of polio SIAs on immunisation systems is frequently debated. We reviewed the impact of polio SIAs on routine immunisation and health systems during the modern era of polio eradication. Methods We searched nine databases for studies reporting on polio SIAs and immunisation coverage, financial investment, workforce and health services delivery. We conducted a narrative synthesis of evidence. Records prior to 1994, animal, modelling or case studies data were excluded. Results 20/1637 unique records were included. Data on vaccine coverage were included in 70% (14/20) studies, workforce in 65% (13/20) and health services delivery in 85% (17/20). SIAs positively contributed to vaccination uptake of non-polio vaccines in seven studies, neutral in three and negative in one. Some polio SIAs contributed to workforce strengthening through training and capacity building. Polio SIAs were accompanied with increased social mobilisation and community awareness building confidence in vaccination programmes. Included studies were programmatic in nature and contained variable data, thus could not be justly critically appraised. Conclusion Polio SIAs are successful at increasing polio vaccine coverage, but the resources and infrastructures were not always utilised for delivery of non-polio vaccines and integration into routine service delivery. We found a gap in standardised tools to evaluate SIAs, which can then inform service integration. Our study provides data to inform SIAs evaluations, and provides important considerations for COVID-19 vaccine roll-out to strengthen health systems. PROSPERO registration number CRD42020152195.
Collapse
Affiliation(s)
- Amy Vassallo
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kimberly Dunbar
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Busayo Ajuwon
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Christopher Lowbridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Martyn Kirk
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Catherine King
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
20
|
Aborode AT, Babatunde AO, Osayomwanbor BAS, Fajemisin EA, Inya OC, Olajiga O, Uwandu-Uzoma AC. Measles outbreak amidst COVID-19 pandemic in Africa: grappling with looming crises. Trop Med Health 2021; 49:89. [PMID: 34727984 PMCID: PMC8561678 DOI: 10.1186/s41182-021-00375-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/02/2021] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) and measles are major threats to the health and wellbeing of Africans. Measles is an endemic disease in Africa with a high mortality rate especially in children despite available vaccines. This letter aims to discuss the impact of the COVID-19 pandemic on prevention and management of measles in Africa. The emergence of COVID-19 has exacerbated the morbidities of measles due to multi-factors like the disruption of mass measles routine vaccination, a monopolistic focus on COVID-19 eradication, malnutrition, and poor surveillance. Currently, the COVID-19 pandemic and looming measles epidemic pose a double burden on the African health sector. We recommend urgent interventions from government and other stakeholders including community leaders to strengthen measles research and vaccination programs in Africa amidst the pandemic.
Collapse
Affiliation(s)
- Abdullahi Tunde Aborode
- Healthy Africans Platform, Research and Development, Ibadan, Nigeria.,Student Against COVID-19, Research and Education, New York, USA
| | - Abdulhammed Opeyemi Babatunde
- Healthy Africans Platform, Research and Development, Ibadan, Nigeria.,Department of Medicine and Surgery, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | - Oko Christian Inya
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Olayinka Olajiga
- Department of Entomology, Kansas State University, Manhattan, USA
| | | |
Collapse
|
21
|
Decouttere C, Banzimana S, Davidsen P, Van Riet C, Vandermeulen C, Mason E, Jalali MS, Vandaele N. Insights into vaccine hesitancy from systems thinking, Rwanda. Bull World Health Organ 2021; 99:783-794D. [PMID: 34737471 PMCID: PMC8542260 DOI: 10.2471/blt.20.285258] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. METHODS Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. FINDINGS A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. CONCLUSION The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.
Collapse
Affiliation(s)
| | - Stany Banzimana
- East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda
| | - Pål Davidsen
- System Dynamics Group, University of Bergen, Bergen, Norway
| | - Carla Van Riet
- Research Center for Access-to-Medicines, Naamsestraat 69, 3000 Leuven, Belgium
| | | | - Elizabeth Mason
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Cambridge, United States of America
| | - Mohammad S Jalali
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Cambridge, United States of America
| | - Nico Vandaele
- Research Center for Access-to-Medicines, Naamsestraat 69, 3000 Leuven, Belgium
| |
Collapse
|
22
|
Eboreime E, Iyamu I, Afirima B, Okechukwu EF, Kibombwe GI, Oladele T, Tafuma T, Badejo OO, Ashiono E, Mpofu M, Oladele EA. COVID-19 risk perception among residents of seven sub-Saharan African countries: socio-demographic correlates and predicted probabilities. Pan Afr Med J 2021; 39:227. [PMID: 34630839 PMCID: PMC8486937 DOI: 10.11604/pamj.2021.39.227.28193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/29/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction as the COVID-19 pandemic rages on, sub-Saharan Africa remains at high risk given the poor adherence to pandemic control protocols. Misconceptions about the contagion may have given rise to adverse risk behaviours across population groups. This study evaluates risk perception among 2,244 residents of seven countries in sub-Saharan Africa (Botswana, Kenya, Malawi, Nigeria, Tanzania, Zambia and Zimbabwe) in relation to socio-demographic determinants. Methods an online survey was conducted via social media platforms to a random sample of participants. Risk perception was evaluated across six domains: loss of income, food scarcity, having a relative infected, civil disorder, criminal attacks, or losing a friend or relative to COVID-19. A multivariable ordinal logistic regression was conducted to assess socio-demographic factors associated with the perceived risk of being affected by COVID-19. Results 595 (27%) respondents did not consider themselves to be at risk, while 33% perceived themselves to be at high risk of being affected by the pandemic with respect to the six domains evaluated. Hospital-based workers had the highest proportional odds (3.5; 95%CI: 2.3-5.6) high perceived risk. Teenage respondents had the highest predictive probability (54.6%; 95% CI: 36.6-72.7%) of perceiving themselves not to be at risk of being affected by COVID-19, while Zambia residents had the highest predictive probability (40.7%; 95% CI: 34.3-47.0%) for high-risk perception. Conclusion this study reveals the need to increase awareness of risks among socio-demographic groups such as younger people and the unemployed. Targeted risk communication strategies will create better risk consciousness, as well as adherence to safety measures.
Collapse
Affiliation(s)
- Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Department of Planning, Research and Statistics, National Primary Health Care Development Agency (NPHCDA), Abuja, Nigeria.,Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria
| | - Ihoghosa Iyamu
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria.,School of Population and Public Health (SPPH), University of British Columbia, Vancouver, Canada
| | - Barinaadaa Afirima
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria
| | - Emeka Franklin Okechukwu
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria.,Family Health International (FHI360), Dar es Salaam, Tanzania
| | - Gabriel Isaac Kibombwe
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria.,Family Health International (FHI360), Lusaka, Zambia
| | - Tolulope Oladele
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria.,Community Prevention and Care Services Department, National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - Taurayi Tafuma
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria
| | - Okiki-Olu Badejo
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Everline Ashiono
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria.,Department of Paediatrics and Child Health, Egerton University, Nakuru, Kenya
| | - Mulamuli Mpofu
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria
| | - Edward Adekola Oladele
- Pan African Research Consortium, Federal Capital Territory, Abuja, Nigeria.,EpiSolution Public Health Services, Federal Capital Territory, Abuja, Nigeria
| |
Collapse
|
23
|
Abdoulaye MB, Oumarou B, Moussa H, Anya BPM, Didier T, Nsiari-Muzeyi BJ, Katoto P, Wiysonge CS. [The impact of the COVID-19 pandemic on health service utilisation in the City of Niamey: a study conducted in 17 health care facilities from January to June 2020]. Pan Afr Med J 2021; 39:159. [PMID: 34539956 PMCID: PMC8434778 DOI: 10.11604/pamj.2021.39.159.28282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
Le défi que pose la pandémie de la COVID-19 sur le système de santé en Afrique est énorme mais pas bien quantifié en ce jour. Nous avons évalué les conséquences de la COVID-19 sur les activités curatives et préventives des formations sanitaires sur une période de six mois au niveau de 17 centres de sante intégré au Niamey de manière en comparant la première moitié de l´année 2020 à celle de l´année 2019. Les différences furent plus prononcées au deuxième trimestre 2020, avec une réduction de 34% (95%IC: -47% à -21%) pour les soins curatifs, 61% (95%IC: -74% à -48%) pour la vaccination aux pentavalents 1 et 3 et de 36% (95%IC: -49% à -23%) pour la VAR 1. Un gain quasi nul de 1% (95%IC: -2% à 4%) fut noté pour la fréquentation à la consultation prénatale annulant ainsi les acquis du premier trimestre. La pandémie de la COVID-19 impacte négativement sur les prestations de service destinées aux groupes les plus à risques de la population à savoir les femmes et les enfants. Des nouvelles stratégies comme l´engagement communautaire sont urgentes.
Collapse
Affiliation(s)
- Mariama Baissa Abdoulaye
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI 1204, Niamey, Niger
| | - Batouré Oumarou
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI 1204, Niamey, Niger
| | - Haladou Moussa
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI 1204, Niamey, Niger
| | | | - Tambwe Didier
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI 1204, Niamey, Niger
| | - Biey Joseph Nsiari-Muzeyi
- Sub-regional Office for West Africa, World Health Organization, Independence street, Gate 0058, Ouagadougou, Burkina Faso
| | - Patrick Katoto
- Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa.,Centre for Tropical Medicine and Global Health, Faculty of Medicine, Catholic University of Bukavu, Bugabo 02, Bukavu, Democratic Republic of Congo.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa
| | - Charles Shey Wiysonge
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, Cape Town, South Africa.,Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley 7501, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7935, Cape Town, South Africa
| |
Collapse
|
24
|
Causal Loop Diagramming of Socioeconomic Impacts of COVID-19: State-of-the-Art, Gaps and Good Practices. SYSTEMS 2021. [DOI: 10.3390/systems9030065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The complexity, multidimensionality, and persistence of the COVID-19 pandemic have prompted both researchers and policymakers to turn to transdisciplinary methods in dealing with the wickedness of the crisis. While there are increasing calls to use systems thinking to address the intricacy of COVID-19, examples of practical applications of systems thinking are still scarce. We revealed and reviewed eight studies which developed causal loop diagrams (CLDs) to assess the impact of the COVID-19 pandemic on a broader socioeconomic system. We find that major drivers across all studies are the magnitude of the infection spread and government interventions to curb the pandemic, while the most impacted variables are public perception of the pandemic and the risk of infection. The reviewed COVID-19 CLDs consistently exhibit certain complexity patterns, for example, they contain a higher number of two- and three-element feedback loops than comparable random networks. However, they fall short in representing linear complexity such as multiple causes and effects, as well as cascading impacts. We also discuss good practices for creating and presenting CLDs using the reviewed diagrams as illustration. We suggest that increasing transparency and rigor of the CLD development processes can help to overcome the lack of systems thinking applications to address the challenges of the COVID-19 crisis.
Collapse
|
25
|
Decouttere C, De Boeck K, Vandaele N. Advancing sustainable development goals through immunization: a literature review. Global Health 2021; 17:95. [PMID: 34446050 PMCID: PMC8390056 DOI: 10.1186/s12992-021-00745-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immunization directly impacts health (SDG3) and brings a contribution to 14 out of the 17 Sustainable Development Goals (SDGs), such as ending poverty, reducing hunger, and reducing inequalities. Therefore, immunization is recognized to play a central role in reaching the SDGs, especially in low- and middle-income countries (LMICs). Despite continuous interventions to strengthen immunization systems and to adequately respond to emergency immunization during epidemics, the immunization-related indicators for SDG3 lag behind in sub-Saharan Africa. Especially taking into account the current Covid19 pandemic, the current performance on the connected SDGs is both a cause and a result of this. METHODS We conduct a literature review through a keyword search strategy complemented with handpicking and snowballing from earlier reviews. After title and abstract screening, we conducted a qualitative analysis of key insights and categorized them according to showing the impact of immunization on SDGs, sustainability challenges, and model-based solutions to these challenges. RESULTS We reveal the leveraging mechanisms triggered by immunization and position them vis-à-vis the SDGs, within the framework of Public Health and Planetary Health. Several challenges for sustainable control of vaccine-preventable diseases are identified: access to immunization services, global vaccine availability to LMICs, context-dependent vaccine effectiveness, safe and affordable vaccines, local/regional vaccine production, public-private partnerships, and immunization capacity/capability building. Model-based approaches that support SDG-promoting interventions concerning immunization systems are analyzed in light of the strategic priorities of the Immunization Agenda 2030. CONCLUSIONS In general terms, it can be concluded that relevant future research requires (i) design for system resilience, (ii) transdisciplinary modeling, (iii) connecting interventions in immunization with SDG outcomes, (iv) designing interventions and their implementation simultaneously, (v) offering tailored solutions, and (vi) model coordination and integration of services and partnerships. The research and health community is called upon to join forces to activate existing knowledge, generate new insights and develop decision-supporting tools for Low-and Middle-Income Countries' health authorities and communities to leverage immunization in its transformational role toward successfully meeting the SDGs in 2030.
Collapse
Affiliation(s)
- Catherine Decouttere
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Kim De Boeck
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| | - Nico Vandaele
- KU Leuven, Access-To-Medicines research Center, Naamsestraat 69, Leuven, Belgium
| |
Collapse
|
26
|
Botwright S, Giersing BK, Meltzer MI, Kahn AL, Jit M, Baltussen R, El Omeiri N, Biey JNM, Moore KL, Thokala P, Mwenda JM, Bertram M, Hutubessy RCW. The CAPACITI Decision-Support Tool for National Immunization Programs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1150-1157. [PMID: 34372981 PMCID: PMC10563585 DOI: 10.1016/j.jval.2021.04.1273] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Immunization programs in low-income and middle-income countries (LMICs) are faced with an ever-growing number of vaccines of public health importance recommended by the World Health Organization, while also financing a greater proportion of the program through domestic resources. More than ever, national immunization programs must be equipped to contextualize global guidance and make choices that are best suited to their setting. The CAPACITI decision-support tool has been developed in collaboration with national immunization program decision makers in LMICs to structure and document an evidence-based, context-specific process for prioritizing or selecting among multiple vaccination products, services, or strategies. METHODS The CAPACITI decision-support tool is based on multi-criteria decision analysis, as a structured way to incorporate multiple sources of evidence and stakeholder perspectives. The tool has been developed iteratively in consultation with 12 countries across Africa, Asia, and the Americas. RESULTS The tool is flexible to existing country processes and can follow any type of multi-criteria decision analysis or a hybrid approach. It is structured into 5 sections: decision question, criteria for decision making, evidence assessment, appraisal, and recommendation. The Excel-based tool guides the user through the steps and document discussions in a transparent manner, with an emphasis on stakeholder engagement and country ownership. CONCLUSIONS Pilot countries valued the CAPACITI decision-support tool as a means to consider multiple criteria and stakeholder perspectives and to evaluate trade-offs and the impact of data quality. With use, it is expected that LMICs will tailor steps to their context and streamline the tool for decision making.
Collapse
Affiliation(s)
| | | | | | | | - Mark Jit
- London School of Hygiene and Tropical Medicine, London, England, UK
| | - Rob Baltussen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nathalie El Omeiri
- Pan American Health Organization, WHO Regional Office for the Americas, Washington, DC, USA
| | - Joseph N-M Biey
- Inter-Country Support Team, Regional Office for Africa, World Health Organization, Ouagadougou, Burkina Faso
| | | | - Praveen Thokala
- University of Sheffield, Western Bank, Sheffield, England, UK
| | - Jason M Mwenda
- WHO Regional Office for Africa, Republic of Congo, Cite du D'Joue, Brazzaville, Congo
| | | | | |
Collapse
|
27
|
Chelo D, Nguefack F, Enyama D, Nansseu R, Feudjo Tefoueyet G, Mbassi Awa HD, Mekone Nkwelle I, Nguefack-Tsague G, Ndenbe P, Koki Ndombo PO. Impact and projections of the COVID-19 epidemic on attendance and routine vaccinations at a pediatric referral hospital in Cameroon. Arch Pediatr 2021; 28:441-450. [PMID: 34140219 PMCID: PMC8188383 DOI: 10.1016/j.arcped.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/05/2021] [Accepted: 05/16/2021] [Indexed: 12/23/2022]
Abstract
Background At the beginning of March 2020, Cameroon experienced its first cases of infection with the new coronavirus (SARS-COV-2). Very quickly, there was a drop in the rate of hospital attendance. The purpose of this study was to observe the variations in the uptake of pediatric consultations and vaccinations in a pediatric hospital. Methods A descriptive and retrospective cross-sectional study was carried out using consultation and vaccination statistics from a pediatric hospital in the city of Yaoundé, political capital of Cameroon, from January 2016 to May 2020. Data were entered in Microsoft Excel and exported to R software (Version 3.3.3) for statistical analysis. First, time series raw data (before and after COVID-19) were plotted and the trend estimated by locally weighted scatterplot smoothing (LOWESS) methods. Then a classic seasonal decomposition was performed to distinguish between seasonal trends and irregular components using moving averages. The Webel–Ollech overall seasonality test (WO test) was also run to formally check for seasonality. The results of the study are presented as narrative tables and graphs. Results Following the partial confinement recommended by the government of Cameroon, the number of pediatric consultations decreased by 52% in April and by 34% in May 2020 compared with rates during the same periods in 2019 (P = 0.00001). For antenatal visits, the rates dropped by 45% and 34%, respectively, in April and May 2020 compared with 2019. The demand for immunization services also declined. As a result, the demand for BCG vaccines, third-dose tracer vaccines (diphtheria, tetanus, pertussis), polio, and MMR in children as well as tetanus vaccines in childbearing women dropped significantly. Conclusion The start of the COVID-19 pandemic was accompanied by a significant drop in consultation and vaccination activities. If no action is taken to correct this phenomenon, the ensuing months could be marked by a considerable increase in patients, sometimes suffering from vaccine-preventable diseases. The death rate could increase considerably in the pediatric population.
Collapse
Affiliation(s)
- D Chelo
- Mother and Child Center Chantal BIYA Foundation, Yaoundé, Cameroon; Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
| | - F Nguefack
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - D Enyama
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - R Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - G Feudjo Tefoueyet
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - H D Mbassi Awa
- Mother and Child Center Chantal BIYA Foundation, Yaoundé, Cameroon; Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - I Mekone Nkwelle
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - G Nguefack-Tsague
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - P Ndenbe
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - P O Koki Ndombo
- Mother and Child Center Chantal BIYA Foundation, Yaoundé, Cameroon; Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| |
Collapse
|
28
|
Impact of COVID-19 on immunization of Brazilian infants. Int J Infect Dis 2021; 107:252-253. [PMID: 33962080 PMCID: PMC8139535 DOI: 10.1016/j.ijid.2021.04.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/23/2022] Open
Abstract
Objective To examine recent vaccination trends among Brazilian children during their first year of life, and the impact of the coronavirus disease 2019 (COVID-19) pandemic on these trends. Methods Monthly vaccination and birth data from the DATASUS (Department of Informatics of the Unified Health System) database of the Ministry of Health of Brazil were obtained from January 2017 to December 2020. Interrupted time series analysis was used to compare vaccination trends before and after March 2020, when isolation measures were first implemented in Brazil. Results There was no strong evidence of a significant change in trends during the study period, or before and during the pandemic at national level. However, the mean number of vaccinations per child was 10.6, which is lower than the 13 doses expected under the immunization schedule. Conclusions Although the pandemic did not appreciably impact on vaccinations, incomplete immunization among children aged <1 year in Brazil is cause for concern. A potential impact of the COVID-19 pandemic on specific antigens or regional and sociodemographic disparities in vaccinations cannot be ruled out without further research.
Collapse
|
29
|
Lieneck C, Herzog B, Krips R. Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9050528. [PMID: 34062813 PMCID: PMC8147259 DOI: 10.3390/healthcare9050528] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 12/15/2022] Open
Abstract
The delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.
Collapse
|
30
|
Kitano T, Aoki H. The incremental burden of invasive pneumococcal disease associated with a decline in childhood vaccination using a dynamic transmission model in Japan: A secondary impact of COVID-19. Comput Biol Med 2021; 133:104429. [PMID: 33930765 PMCID: PMC8065234 DOI: 10.1016/j.compbiomed.2021.104429] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disrupted childhood vaccinations, including pneumococcal conjugate vaccine (PCV). Evaluating the possible impact on the invasive pneumococcal disease (IPD) incidence associated with a decline in childhood pneumococcal vaccination is important to advocate the PCV programs. Using a deterministic, dynamic transmission model, the differential incidence and burden of IPD in children younger than 5 years in Japan were estimated between the rapid vaccination recovery (January 2021) and the delayed vaccination recovery (April 2022) scenarios for the next 10 years. In our model, the IPD incidence was reduced from 11.9/100,000 in 2019 to 6.3/100,000 in 2020, caused by a reduced transmission rate due to the COVID-19 mitigation measures. Assuming a recovery in the transmission rate in 2022 April, the incidence of IPD was estimated to increase with maximal incidence of 12.1 and 13.1/100,000 children under 5 years in the rapid and the delayed vaccination recovery scenarios. The difference in the total IPD incidence between these two scenarios was primarily driven by vaccine serotypes IPD incidence. The difference of incidence was not observed between the two scenarios after 2025. The persistent decline in childhood pneumococcal vaccination rates due to the impact of COVID-19 might lead to an increased IPD incidence and an incremental disease burden.
Collapse
Affiliation(s)
- Taito Kitano
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
| | - Hirosato Aoki
- Department of Neonatology, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa, 232-8555, Japan
| |
Collapse
|
31
|
Wale Tegegne A, Kassie Gidafie A, Girma Mamo D, Tilahun Wassie S, Abita Mengie Z. Immunization Status and Challenges During COVID-19 and Associated Factors Among Children Aged 10-23 Months in South Region, Ethiopia 2020. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:101-109. [PMID: 33727881 PMCID: PMC7954040 DOI: 10.2147/phmt.s294739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/22/2021] [Indexed: 12/23/2022]
Abstract
Background The worldwide COVID-19 pandemic is overstressing health systems and Essential health services and vaccination services are disrupted. Immunization is a confirmed gizmo for governing and even eliminating communicable diseases. Objective This study aims to assess the challenge and status of immunization during COVID-19 and associated factors among children aged 10–23 months south Nation Nationality and People Region Ethiopia. Methods and Materials: community-based mixed quantitative and qualitative cross-sectional study was done in southwest Ethiopia. Data was collected using semi-structured questionnaires and in-depth interviews. After that, the data were edited, coded, and move in into Epi info version 7.2 for data management then transported to SPSS version 25 for analysis. The analyzed data were presented by tables, graphs, figures, and text form. Results According to this study, the prevalence of incomplete immunization was found to be 809 (62.2%) with (95% CI: 59.5, 64.8). In multivariable analysis waiting time at a health facility (AOR=0.04, 95% CI 0.0001,0.004), education (AOR=5.08,95% CI2.31,11.14), place of delivery (AOR=2.34,95% CI 4.96,6.089), fearing of COVID-19 (AOR=3.62,95% CI 1.72,7.64) and do not understand the separation care of COVID-19 and other health services (AOR=2.85,95% CI1.38,5.9) were significantly associated factors. Conclusion The prevalence of incomplete immunization among children aged 10–23 months was very high in this study as compared to the other studies done in a different pocket of Ethiopia. Consecutively, reducing waiting time at a health facility, avoiding unnecessary fear of COVID-19, and promoting immunization in a different area of southwest Ethiopia along with health extension workers are recommended.
Collapse
Affiliation(s)
- Alemnew Wale Tegegne
- Department of Midwifery, College of Medicine and Health Science, Mizan Tepi University, Tepi, Ethiopia
| | - Aychew Kassie Gidafie
- Department of Nursing, College of Medicine and Health Science, Mizan Tepi University, Tepi, Ethiopia
| | - Desalegn Girma Mamo
- Department of Midwifery, College of Medicine and Health Science, Mizan Tepi University, Tepi, Ethiopia
| | - Semahegn Tilahun Wassie
- Department of Midwifery, College of Medicine and Health Science, Mizan Tepi University, Tepi, Ethiopia
| | - Zinie Abita Mengie
- Department of Midwifery, College of Medicine and Health Science, Mizan Tepi University, Tepi, Ethiopia
| |
Collapse
|
32
|
Global COVID-19 vaccine equity should precede requiring travelers proof of vaccination. Int J Infect Dis 2021; 105:243-244. [PMID: 33640569 PMCID: PMC7906856 DOI: 10.1016/j.ijid.2021.02.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 12/23/2022] Open
|
33
|
Abstract
SARS-CoV-2, with an infection fatality rate between 0.5 and 1%, has spread to all corners of the globe and infected millions of people. While vaccination is essential to protect against the virus and halt community transmission, rapidly making and delivering safe and efficacious vaccines presents unique development, manufacturing, supply chain, delivery, and post-market surveillance challenges. Despite the large number of vaccines in or entering the clinic, it is unclear how many candidates will meet regulatory requirements and which vaccine strategy will most effectively lead to sustained, population-wide immunity. Interviews with experts from biopharmaceutical companies, regulatory and multilateral organizations, non-profit foundations, and academic research groups, complemented with extensive literature review, informed the development of a framework for understanding the factors leading to population-wide immunity against SARS-CoV-2, in particular considering the role of vaccines. This paper presents a systems-level modeling framework to guide the development of analytical tools aimed at informing time-critical decisions to make vaccines globally and equitably accessible. Such a framework can be used for scenario planning and evaluating tradeoffs across access strategies. It highlights the diverse and powerful ways in which data can be used to evaluate future risks and strategically allocate limited resources.
Collapse
|