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Sangeda RZ, James D, Mariki H, Mbwambo ME, Mwenesi ME, Nyaki H, Tinuga F, Manyanga DP. Childhood vaccination trends during 2019 to 2022 in Tanzania and the impact of the COVID-19 pandemic. Hum Vaccin Immunother 2024; 20:2356342. [PMID: 38780570 PMCID: PMC11123454 DOI: 10.1080/21645515.2024.2356342] [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: 12/22/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
The COVID-19 pandemic has significantly disrupted healthcare systems at all levels globally, notably affecting routine healthcare services, such as childhood vaccination. This study examined the impact of these disruptions on routine childhood vaccination programmes in Tanzania. We conducted a longitudinal study over four years in five Tanzanian regions: Mwanza, Dar es Salaam, Mtwara, Arusha, and Dodoma. This study analyzed the trends in the use of six essential vaccines: Bacille Calmette-Guérin (BCG), bivalent Oral Polio Vaccine (bOPV), Diphtheria Tetanus Pertussis, Hepatitis-B and Hib (DTP-HepB-Hib), measles-rubella (MR), Pneumococcal Conjugate Vaccine (PCV), and Rota vaccines. We evaluated annual and monthly vaccination trends using time-series and regression analyses. Predictive modeling was performed using an autoregressive integrated moving average (ARIMA) model. A total of 32,602,734 vaccination events were recorded across the regions from 2019 to 2022. Despite declining vaccination rates in 2020, there was a notable rebound in 2021, indicating the resilience of Tanzania's immunization program. The analysis also highlighted regional differences in vaccination rates when standardized per 1000 people. Seasonal fluctuations were observed in monthly vaccination rates, with BCG showing the most stable trend. Predictive modeling of BCG indicated stable and increasing vaccination coverage by 2023. These findings underscore the robustness of Tanzania's childhood immunization infrastructure in overcoming the challenges posed by the COVID-19 pandemic, as indicated by the strong recovery of vaccination rates post-2020. We provide valuable insights into the dynamics of vaccination during a global health crisis and highlight the importance of sustained immunization efforts to maintain public health.
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Affiliation(s)
- Raphael Zozimus Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Daniel James
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Harrison Mariki
- Department of Research and Development, Afya Intelligence, Dar es Salaam, Tanzania
| | - Mbonea Erick Mbwambo
- Department of Research and Development, Afya Intelligence, Dar es Salaam, Tanzania
| | - Mwendwa E. Mwenesi
- Immunization and Vaccine Development, Ministry of Health Tanzania, Dodoma, Tanzania
| | - Honesti Nyaki
- Immunization and Vaccine Development, Ministry of Health Tanzania, Dodoma, Tanzania
| | - Florian Tinuga
- Immunization and Vaccine Development, Ministry of Health Tanzania, Dodoma, Tanzania
| | - Daudi Peter Manyanga
- Department of Universal Health Coverage, Communicable & Non-Communicable Diseases, World Health Organization Inter-Country Support Team for East and Southern African Countries, Harare, Zimbabwe
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Hartner AM, Li X, Gaythorpe K. COVID-19 related disruption and resilience in immunisation activities in LMICs: a rapid review. BMJ Open 2024; 14:e076607. [PMID: 39107008 PMCID: PMC11331918 DOI: 10.1136/bmjopen-2023-076607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/19/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVES We conducted a rapid review to determine the extent that immunisation services in low-income and middle-income countries (LMICs) were disrupted by the COVID-19 pandemic and synthesised the factors that can be used to build resilience in future. DESIGN Rapid review reported in accordance with the Preferred reporting for Systematic reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES PubMed and Web of Science were searched through 6 October 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies that focused on disruption to immunisation activities due to the COVID-19 pandemic in LMICs. Outcomes included routine vaccine coverage, supplementary immunisation activities, vaccine doses, timing of vaccination, supply chain changes, and factors contributing to disruption or resilience. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search, screen and code studies. Quality assessment was performed using a modified version of the Critical Appraisal Skills Programme for qualitative research. Findings were summarised qualitatively. RESULTS Of 4978 identified studies, 85 met the eligibility criteria. Included studies showed declines in immunisation activities across LMICs related to the COVID-19 pandemic. These included reductions in achieved routine coverage, cancellation or postponement of campaigns and underimmunised cohorts. Immunisation was most disrupted in the early months of the pandemic; however, recovery varied by country, age-group and vaccine. Though many countries observed partial recovery in 2020, disruption in many countries continued into 2021. It has also been noted that clinician staff shortages and vaccine stock-outs caused by supply chain disruptions contributed to immunisation delays, but that concern over COVID-19 transmission was a leading factor. Key resiliency factors included community outreach and healthcare worker support. CONCLUSIONS There is limited information on whether reductions in vaccination coverage or delays have persisted beyond 2021. Further research is needed to assess ongoing disruptions and identify missed vaccine cohorts.
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Affiliation(s)
- Anna-Maria Hartner
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
- Centre for Artificial Intelligence in Public Health Research, Robert Koch Institute, Wildau, Germany
| | - Xiang Li
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Katy Gaythorpe
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK
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Abu-Farha RK, Khabour OF, Gharaibeh L, Elrahal YM, Alzoubi KH, Nassar R, Harahsheh MM, Binsaleh AY, Shilbayeh SA. Navigating parental attitudes on childhood vaccination in Jordan: a cross-sectional study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-13. [PMID: 38620051 DOI: 10.1080/09603123.2024.2342018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/07/2024] [Indexed: 04/17/2024]
Abstract
This study investigated parental attitudes toward childhood vaccination in Jordan, focusing on acceptance, concerns, and perceptions. A cross-sectional survey conducted from January to February 2024 included 939 parents. Findings indicated that 85.4% (n = 802) of respondents received the COVID-19 vaccine, while only 25% (n = 229) vaccinated their children. Concerns regarding vaccine safety and efficacy were prevalent, with 63.9% (n = 600) expressing worries about side effects and 46.9% (n = 440) trusting immunization programs. Post-pandemic, 34% (n = 319) reported a more negative attitude. Logistic regression showed parents not vaccinating their children against COVID-19 were significantly less likely to exhibit positive attitudes toward childhood vaccination (OR = 0.412, p < 0.001). Older participants were more inclined toward negativity post-pandemic (OR = 1.031, p = 0.007). In conclusion, parental attitudes shifted post-COVID-19, reflecting hesitancy and decreased trust. Addressing concerns and restoring confidence are crucial, especially for children's health. Education through healthcare providers and dispelling social media misinformation are essential. Implementing strategies to enhance post-pandemic vaccine acceptance is imperative for preventing outbreaks of vaccine-preventable diseases.
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Affiliation(s)
- Rana K Abu-Farha
- Clinical Pharmacy and Therapeutics Department, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Lobna Gharaibeh
- Biopharmaceutics and Clinical Pharmacy Department, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Yusra M Elrahal
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, UAE
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Razan Nassar
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Meaad M Harahsheh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Ammena Y Binsaleh
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sireen A Shilbayeh
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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4
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Humble RM, Dubé E, Olson J, Scott SD, MacDonald SE. Routine childhood vaccination among ethnocultural groups in Canada during the COVID-19 pandemic: A national cross-sectional study. Prev Med Rep 2023; 36:102435. [PMID: 37822977 PMCID: PMC10562748 DOI: 10.1016/j.pmedr.2023.102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
Some ethnocultural groups in Canada experience low routine childhood vaccination, with social locations and discriminations contributing to inequities. This study aimed to characterize routine childhood vaccination in the context of the COVID-19 pandemic, including the influence of discriminatory experiences when accessing health services. We conducted a cross-sectional national survey to assess parents' acceptance of routine vaccines for their children ≤ 17 years in Oct/Nov 2021. Descriptive statistics were used to explore differences among ethnocultural groups and logistic regression to assess associations with parents' low acceptance. Of 2531 parents, 21.8 % self-identified as Racialized minorities, 7.7 % Indigenous, 23.3 % newcomers, 10.0 % spoke minority languages most often, and 69.6 % belonged to a reference group who did not report these characteristics. Statistically significant findings included 36.6 % of Indigenous parents reporting that the pandemic made them realize that routine vaccines were more important compared to 16.7 % of newcomers. Discrimination/racism when accessing health services was most often experienced by Indigenous (27.8 %) and Racialized minorities (20.2 %), compared to the reference group (4.8 %). Racialized minorities were more likely to report low acceptance of routine vaccination (aOR = 2.19, 95 % CI: 1.18-4.05), and younger parents and those with only preschool-aged children were less likely to have low acceptance (aOR = 0.59, 95 % CI: 0.37-0.94; aOR = 0.53, 95 % CI: 0.36, 0.79). Low acceptance was associated with everyday stress preventing vaccination (aOR = 2.18, 95 % CI: 1.41-3.38). Public health decision-makers should ensure equitable access to routine childhood vaccination that targets the inclusion of ethnocultural groups, who may experience disproportionate barriers and low acceptance.
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Affiliation(s)
- Robin M. Humble
- 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
| | - Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Kanaan D, Al-Khazali MN, Khalid IW, Abu-Ekteish F, Al-Sweedan S. An Unusual Complication of Measles Infection in a Pediatric Patient: A Case Report of Measles-Induced Hemophagocytic Lymphohistiocytosis (HLH) From Jordan. Cureus 2023; 15:e48144. [PMID: 38046741 PMCID: PMC10692959 DOI: 10.7759/cureus.48144] [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: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Measles is a highly contagious infection that leads to many serious complications. Despite the significant global effort to eradicate it, it still represents a major threat due to suboptimal vaccination coverage, especially after the coronavirus disease 2019 (COVID-19) pandemic that affected all routine childhood vaccinations. One of its fatal complications, which has been reported a few times in the literature, is hemophagocytic lymphohistiocytosis (HLH). We discuss a case of a 14-month-old unvaccinated female patient who developed measles-induced HLH and was treated with intravenous immunoglobulins (IVIG) and steroids; unfortunately, she developed multiorgan failure and passed away before chemotherapy could be initiated.
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Affiliation(s)
- Dana Kanaan
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, JOR
| | - Mohammad N Al-Khazali
- Department of Pediatrics, Princess Rahma Teaching Hospital, Jordanian Ministry of Health, Irbid, JOR
| | - Israa W Khalid
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, JOR
| | - Faisal Abu-Ekteish
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, JOR
| | - Suleimman Al-Sweedan
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, JOR
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Abdollahifard S, Farrokhi A, Mowla A. Application of deep learning models for detection of subdural hematoma: a systematic review and meta-analysis. J Neurointerv Surg 2023; 15:995-1000. [PMID: 36418163 DOI: 10.1136/jnis-2022-019627] [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: 09/13/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study aimed to investigate the application of deep learning (DL) models for the detection of subdural hematoma (SDH). METHODS We conducted a comprehensive search using relevant keywords. Articles extracted were original studies in which sensitivity and/or specificity were reported. Two different approaches of frequentist and Bayesian inference were applied. For quality and risk of bias assessment we used Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). RESULTS We analyzed 22 articles that included 1,997,749 patients. In the first step, the frequentist method showed a pooled sensitivity of 88.8% (95% confidence interval (CI): 83.9% to 92.4%) and a specificity of 97.2% (95% CI 94.6% to 98.6%). In the second step, using Bayesian methods including 11 studies that reported sensitivity and specificity, a sensitivity rate of 86.8% (95% CI: 77.6% to 92.9%) at a specificity level of 86.9% (95% CI: 60.9% to 97.2%) was achieved. The risk of bias assessment was not remarkable using QUADAS-2. CONCLUSION DL models might be an appropriate tool for detecting SDHs with a reasonably high sensitivity and specificity.
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Affiliation(s)
- Saeed Abdollahifard
- Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirmohammad Farrokhi
- Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
- Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Mowla
- Neurological Surgery, University of Southern California, Los Angeles, California, USA
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Kansal V, Burnham AJ, Kinney BLC, Saba NF, Paulos C, Lesinski GB, Buchwald ZS, Schmitt NC. Statin drugs enhance responses to immune checkpoint blockade in head and neck cancer models. J Immunother Cancer 2023; 11:jitc-2022-005940. [PMID: 36650022 PMCID: PMC9853267 DOI: 10.1136/jitc-2022-005940] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Anti-PD-1 immune checkpoint blockade is approved for first-line treatment of recurrent/metastatic head and neck squamous cell carcinoma (HNSCC), but few patients respond. Statin drugs (HMG-CoA reductase inhibitors) are associated with superior survival in several cancer types, including HNSCC. Emerging data suggest that manipulation of cholesterol may enhance some aspects of antitumor immunity. METHODS We used syngeneic murine models (mouse oral cancer, MOC1 and TC-1) to investigate our hypothesis that a subset of statin drugs would enhance antitumor immunity and delay tumor growth. RESULTS Using an ex vivo coculture assay of murine cancer cells and tumor infiltrating lymphocytes, we discovered that all seven statin drugs inhibited tumor cell proliferation. Simvastatin and lovastatin also enhanced T-cell killing of tumor cells. In mice, daily oral simvastatin or lovastatin enhanced tumor control and extended survival when combined with PD-1 blockade, with rejection of MOC1 tumors in 30% of mice treated with lovastatin plus anti-PD-1. Results from flow cytometry of tumors and tumor-draining lymph nodes suggested T cell activation and shifts from M2 to M1 macrophage predominance as potential mechanisms of combination therapy. CONCLUSIONS These results suggest that statins deserve further study as well-tolerated, inexpensive drugs that may enhance responses to PD-1 checkpoint blockade and other immunotherapies for HNSCC.
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Affiliation(s)
- Vikash Kansal
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA,Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Andre J Burnham
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA,Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Brendan L C Kinney
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA,Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chrystal Paulos
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA,Departments of Surgery and Microbiology/Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gregory B Lesinski
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Nicole C Schmitt
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA,Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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8
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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.
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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.
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Atkinson KM, Ntacyabukura B, Hawken S, Laflamme L, Wilson K. Effects of the COVID-19 pandemic on self-reported 12-month pneumococcal vaccination series completion rates in Canada. Hum Vaccin Immunother 2022; 18:2158005. [PMID: 36581328 PMCID: PMC9891678 DOI: 10.1080/21645515.2022.2158005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Routine childhood vaccination improves health and prevents morbidity and mortality from vaccine-preventable diseases. There are indications that the COVID-19 pandemic has negatively impacted immunization rates globally, but systematic studies on this are still lacking in Canada. This study aims to add knowledge on the pandemic's effect on children's immunization rates with pneumococcal vaccine using self-reported immunization data from CANImmunize. An interrupted time series analysis was conducted on aggregated monthly enrollment of children on the platform (2016-2021) and their pneumococcal immunization series completion rates (2016-2020). Predicted trends before and after the onset of the COVID19-related restriction (March 1, 2020) were compared by means of an Autoregressive Integrated Moving Average (ARIMA). The highest monthly enrollment was 3,474 new infant records observed in January 2020, and the lowest was 100 records in December 2021. The highest Self-reported pneumococcal immunization series completion rate was 78.89%, observed in February 2017, and the lowest was 6.94% in December 2021. Enrollment decreased by 1177.52 records (95% CI: -1865.47, -489.57), with a continued decrease of 80.84 records each month. Completion rates had an immediate increase of 14.57% (95% CI 4.64, 24.51), followed by a decrease of 3.54% each month. The onset of the COVID-19 related restrictions impacted the enrollment of children in the CANImmunize digital immunization platform and an overall decrease in self-reported pneumococcal immunization series completion rates. Our findings support efforts to increase catch-up immunization campaigns so that children who could not get scheduled immunization during the pandemic are not missed.
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Affiliation(s)
| | - Blaise Ntacyabukura
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
| | - Lucie Laflamme
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada,Bruyere Research Institute, Ottawa, Canada,Department of Medicine, University of Ottawa, Ottawa, Canada,CONTACT Kumanan Wilson Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Canada
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Rahman MA, Sultana S, Kundu S, Islam MA, Roshid HO, Khan ZI, Tohan M, Jahan N, Khan B, Howlader MH. Trends and patterns of inequalities in using facility delivery among reproductive-age women in Bangladesh: a decomposition analysis of 2007-2017 Demographic and Health Survey data. BMJ Open 2022; 12:e065674. [PMID: 36581408 PMCID: PMC9806084 DOI: 10.1136/bmjopen-2022-065674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The prime objectives of the study were to measure the prevalence of facility delivery, assess socioeconomic inequalities and determine potential associated factors in the use of facility delivery in Bangladesh.DesignCross-sectional. SETTING The study involved investigation of nationally representative secondary data from the Bangladesh Demographic and Health Survey between 2007 and 2017-2018. PARTICIPANTS The participants of this study were 30 940 (weighted) Bangladeshi women between the ages of 15 and 49. METHODS Decomposition analysis and multivariable logistic regression were both used to analyse data to achieve the study objectives. RESULTS The prevalence of using facility delivery in Bangladesh has increased from 14.48% in 2007 to 49.26% in 2017-2018. The concentration index for facility delivery utilisation was 0.308 with respect to household wealth status (p<0.001), indicating that use of facility delivery was more concentrated among the rich group of people. Decomposition analysis also indicated that wealth quintiles (18.31%), mothers' education (8.78%), place of residence (7.75%), birth order (5.56%), partners' education (4.30%) and antenatal care (ANC) seeking (8.51%) were the major contributors to the prorich socioeconomic inequalities in the use of facility delivery. This study found that women from urban areas, were overweight, had any level of education, from wealthier families, had ANC, and whose partners had any level of education and involved in business were more likely to have facility births compared with their respective counterparts. CONCLUSIONS This study found a prorich inequality in the use of facility delivery in Bangladesh. The socioeconomic disparities in facility delivery must be addressed if facility delivery usage is to increase in Bangladesh.
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Affiliation(s)
| | - Sumaya Sultana
- Development Studies, Khulna University, Khulna, Bangladesh
| | - Satyajit Kundu
- Global Health Institute, North South University, Dhaka, Bangladesh
- School of Public Health, Southeast University, Nanjing, People's Republic of China
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | | | - Harun Or Roshid
- Statistics Discipline, Khulna University, Khulna, Bangladesh
| | | | - Mortuza Tohan
- Development Studies, Khulna University, Khulna, Bangladesh
| | - Nusrat Jahan
- Development Studies, Khulna University, Khulna, Bangladesh
| | - Bayezid Khan
- Development Studies, Khulna University, Khulna, Bangladesh
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