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Packham A, Taylor AE, Karangwa MP, Sherry E, Muvunyi C, Green CA. Measles Vaccine Coverage and Disease Outbreaks: A Systematic Review of the Early Impact of COVID-19 in Low and Lower-Middle Income Countries. Int J Public Health 2024; 69:1606997. [PMID: 38725903 PMCID: PMC11079172 DOI: 10.3389/ijph.2024.1606997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives: We aimed to evaluate changes to measles-containing vaccine (MCV) provision and subsequent measles disease cases in low- and lower-middle income countries (LICs, LMICs) in relation to the COVID-19 pandemic. Methods: A systematic search was conducted of MEDLINE, OVID EMBASE and PubMed records. Primary quantitative and qualitative research studies published from January 2020 were included if they reported on COVID-19 impact on MCV provision and/or measles outbreak rates within LICs and LMICs. Results: 45 studies were included. The change in MCV1 vaccination coverage in national and international regions ranged -13% to +44.4% from pre-COVID time periods. In local regions, the median MCV1 and overall EPI rate changed by -23.3% and -28.5% respectively. Median MCV2 rate was disproportionally impacted in local areas during COVID-interruption time-periods (-48.2%) with ongoing disruption in early-recovery time-periods (-17.7%). 8.9% of studies reported on vaccination status of confirmed measles cases; from these, 71%-91% had received no MCV dose. Conclusion: MCV vaccination coverage experienced ongoing disruption during the recovery periods after initial COVID-19 disruption. Vaccination in local area datasets notably experienced longer-term disruption compared to nationally reported figures.
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Affiliation(s)
- Alice Packham
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Alice E. Taylor
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Emma Sherry
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | | | - Christopher A. Green
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, England, United Kingdom
- Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Kisanga A, Stamidis KV, Rumbe S, Lamunu D, Ben A, Thomas GR, Berchmans J. Leveraging the CORE Group Partners Project Polio Infrastructure to Integrate COVID-19 Vaccination and Routine Immunization in South Sudan. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300178. [PMID: 38129123 PMCID: PMC10948123 DOI: 10.9745/ghsp-d-23-00178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Countries with fragile health systems like South Sudan experienced significant impacts on routine immunization during the COVID-19 pandemic. Routine immunization in children aged younger than 1 year declined due to pandemic-related constraints and was compounded by the introduction of the COVID-19 vaccine, which was met with hesitancy and reluctance. When South Sudan reported the first COVID-19 case in March 2020, the CORE Group Partners Project (CGPP) rapidly integrated the COVID-19 outbreak response into its ongoing polio eradication activities, leveraging the existing polio infrastructure and human resources. We describe the integration process, results, and challenges and detail the impact of the integration on coverage for both routine immunization and COVID-19 vaccinations. METHODS Efforts to integrate COVID-19 vaccination and routine immunization service delivery were implemented in 5 phases: assessing the need, developing multisector collaborations, developing a service delivery plan, assessing implementation readiness, and implementing and evaluating the service delivery plan. Integration efforts prioritized coordination, training vaccinators and volunteers, development of microplans, data management, and last-mile vaccine delivery. Integrated service delivery was implemented through "one-stop shop" sessions where communities accessed routine immunizations for children, COVID-19 vaccinations for adults, and other primary health services. RESULTS Integrating health service delivery contributed to improved routine immunization coverage among children, improved COVID-19 vaccination coverage among adults, reduced cost for service delivery, and increased access to more comprehensive health services in hard-to-reach communities. COVID-19 vaccinations were delivered at US$4.70 per dose, a cost substantially lower than other reported delivery mechanisms. CONCLUSION Integration can yield positive results and improve access to vaccination and other health services for communities. However, it requires clear policy guidelines, commitment, and strong collaboration. Challenges included resistance from stakeholders, overstretched human resources, and diversion of funding and attention from program areas, which were overcome through deliberate high-level advocacy, partnership, and intensified community engagement.
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Affiliation(s)
| | | | - Samuel Rumbe
- CORE Group Partners Project South Sudan, Juba, South Sudan
| | - Doris Lamunu
- CORE Group Partners Project South Sudan, Juba, South Sudan
| | - Adil Ben
- CORE Group Partners Project South Sudan, Juba, South Sudan
| | | | - Jean Berchmans
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Wariri O, Utazi CE, Okomo U, Sowe A, Sogur M, Fofanna S, Ezeani E, Saidy L, Sarwar G, Dondeh BL, Murray KA, Grundy C, Kampmann B. Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015-2021. BMJ Glob Health 2023; 8:e014225. [PMID: 38148110 PMCID: PMC10753753 DOI: 10.1136/bmjgh-2023-014225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused widespread morbidity and mortality and resulted in the biggest setback in routine vaccinations in three decades. Data on the impact of the pandemic on immunisation in Africa are limited, in part, due to low-quality routine or administrative data. This study examined coverage and timeliness of routine childhood immunisation during the pandemic in The Gambia, a country with an immunisation system considered robust. METHODS We obtained prospective birth cohort data of 57 286 children in over 300 communities in two health and demographic surveillance system sites, including data from the pre-pandemic period (January 2015-February 2020) and the three waves of the pandemic period (March 2020-December 2021). We determined monthly coverage and timeliness (early and delayed) of the birth dose of hepatitis B vaccine (HepB0) and the first dose of pentavalent vaccine (Penta1) during the different waves of the pandemic relative to the pre-pandemic period. We implemented a binomial interrupted time-series regression model. RESULT We observed no significant change in the coverage of HepB0 and Penta1 vaccinations from the pre-pandemic period up until the periods before the peaks of the first and second waves of the pandemic in 2020. However, there was an increase in HepB0 coverage before as well as after the peak of the third wave in 2021 compared with the pre-pandemic period (pre-third wave peak OR = 1.83, 95% CI 1.06 to 3.14; post-third wave period OR=2.20, 95% CI 1.23 to 3.92). There was some evidence that vaccination timeliness changed during specific periods of the pandemic. Early Penta1 vaccination decreased by 70% (OR=0.30, 95% CI 0.12 to 0.78) in the period before the second wave, and delayed HepB0 vaccination decreased by 47% (OR=0.53, 95% CI 0.29 to 0.97) after the peak of the third wave in 2021. CONCLUSION Despite the challenges of the COVID-19 pandemic, The Gambia's routine vaccination programme has defied the setbacks witnessed in other settings and remained resilient, with coverage increasing and timeliness improving during the second and third waves. These findings highlight the importance of having adequate surveillance systems to monitor the impact of large shocks to vaccination coverage and timeliness.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, UK
- Southampton Statistical Sciences Research Institute, , University of Southampton, Southampton, UK
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Alieu Sowe
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Malick Sogur
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Sidat Fofanna
- Expanded Programme on Immunization, Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Esu Ezeani
- Health and Demographic Surveillance System (HDSS), MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Lamin Saidy
- Data Management & Architecture, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Golam Sarwar
- Health and Demographic Surveillance System (HDSS), MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Bai-Lamin Dondeh
- Data Management & Architecture, MRC Unit The Gambia a London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Kris A Murray
- Centre on Climate Change and Planetary Health, MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global Health, Charité Universitatsmedizin Berlin, Berlin, Germany
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Omale UI, Iyare O, Ewah RL, Amuzie CI, Oka OU, Uduma VU, Adeke AS, Ikegwuonu CO, Nnachi OO, Ukpabi OO, Okeke IM, Nkwo GE, Nwali UI. COVID-19 vaccination acceptance among community members and health workers in Ebonyi state, Nigeria: study protocol for a concurrent-independent mixed method analyses of intention to receive, timeliness of the intention to receive, uptake and hesitancy to COVID-19 vaccination and the determinants. BMJ Open 2022; 12:e061732. [PMID: 36521883 PMCID: PMC9755909 DOI: 10.1136/bmjopen-2022-061732] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has gravely affected the lives and economies of the global population including Nigeria. The attainment of herd immunity through mass COVID-19 vaccination is the foremost control strategy, however, the deployments of COVID-19 vaccinations are facing challenges of non-acceptance. Despite the efforts of the Nigerian government and COVAX facility in making COVID-19 vaccination more available/accessible, the vaccination rate remains unexpectedly very low in Nigeria/Ebonyi state. Therefore, it is important to investigate the acceptability of COVID-19 vaccination to elucidate the explanations for the very low coverage rate. This study aims to evaluate/explore COVID-19 vaccination acceptance and the determinants among community members and health workers in Ebonyi state, Nigeria. METHODS AND ANALYSES The study is an analytical cross-sectional survey with a concurrent-independent mixed method design. Quantitative data will be collected from all consenting/assenting community members aged 15 years and above, in 28 randomly selected geographical clusters, through structured interviewer-administered questionnaire household survey using KoBoCollect installed in android devices. Quantitative data will be collected from all consenting health workers, selected via convenience and snowball techniques, through structured self-administered questionnaire survey distributed via WhatsApp and interviewer-administered survey using KoBoCollect installed in android devices. Qualitative data will be collected from purposively selected community members and health workers through focus group discussions. Quantitative analyses will involve descriptive statistics, generalised estimating equations (for community members data) and generalised linear model (for health workers data). Qualitative analyses will employ the thematic approach. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the Ebonyi State Health Research and Ethics Committee (EBSHREC/15/01/2022-02/01/2023) and Research and Ethics Committee of Alex Ekwueme Federal University Teaching Hospital Abakaliki (14/12/2021-17/02/2022), and verbal consent will be obtained from participants. Study findings will be reported at local, national and international levels as appropriate. TRIAL REGISTRATION NUMBER ISRCTN16735844.
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Affiliation(s)
- Ugwu I Omale
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Osarhiemen Iyare
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Richard L Ewah
- Department of Anaesthesia, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
- Anaesthesia Unit, Department of Surgery, Ebonyi State University, Abakaliki, Nigeria
| | - Chidinma I Amuzie
- Department of Community Medicine, Federal Medical Centre, Umuahia, Nigeria
| | - Onyinyechukwu U Oka
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Victor U Uduma
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Azuka S Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Cordis O Ikegwuonu
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Olaedo O Nnachi
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Okechukwu O Ukpabi
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Ifeyinwa M Okeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
| | - Glory E Nkwo
- Department of Community Medicine, Federal Medical Centre, Umuahia, Nigeria
| | - Ugochi Ia Nwali
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Abakaliki, Nigeria
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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.
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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
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Rodrigues RN, do Nascimento GLM, Arroyo LH, Arcêncio RA, de Oliveira VC, Guimarães EADA. The COVID-19 pandemic and vaccination abandonment in children: spatial heterogeneity maps. Rev Lat Am Enfermagem 2022; 30:e3642. [PMID: 36228235 PMCID: PMC9545939 DOI: 10.1590/1518-8345.6132.3642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/03/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE to identify spatial clusters corresponding to abandonment of routine vaccines in children. METHOD an ecological study, according to data from the 853 municipalities of a Brazilian state. The records analyzed were those of the multidose pentavalent, pneumococcal 10-valent, inactivated poliomyelitis and oral human rotavirus vaccines of 781,489 children aged less than one year old. The spatial scan statistics was used to identify spatial clusters and assess the relative risk based on the vaccination abandonment indicator. RESULTS the spatial scan statistics detected the presence of statistically significant clusters for abandonment regarding the four vaccines in all the years analyzed. However, the highest number of clusters with high relative risk estimates was identified in 2020. The Vale do Aço and West, North and West, and Southwest regions stand out for the pentavalent, poliomyelitis and rotavirus vaccines, respectively. CONCLUSION in an attempt to mitigate the devastating impact of the COVID-19 pandemic, the immunization program experienced setbacks. The presence of clusters points to the need to implement integrated strategies that may involve different sectors for an active search for children and prevent outbreaks of vaccine-preventable diseases in the near future.
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Affiliation(s)
| | | | | | - Ricardo Alexandre Arcêncio
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem,
Ribeirão Preto, SP, Brazil
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Formenti B, Gregori N, Crosato V, Marchese V, Tomasoni LR, Castelli F. The impact of COVID-19 on communicable and non-communicable diseases in Africa: a narrative review. LE INFEZIONI IN MEDICINA 2022; 30:30-40. [PMID: 35350264 DOI: 10.53854/liim-3001-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/20/2022] [Indexed: 01/06/2023]
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) has disproportionately impacted global human health, economy, and security. Because of weaker health-care systems, existing comorbidities burden (HIV, malaria, tuberculosis, and non-communicable conditions), and poor socioeconomic determinants, initial predictive models had forecast a disastrous impact of COVID-19 in Africa in terms of transmission, severity, and deaths. Nonetheless, current epidemiological data seem not to have matched expectations, showing lower SARS-CoV-2 infection and fatality rates compared to Europe, the Americas and Asia. However, only few studies were conducted in low- and middle-income African settings where high poverty and limited access to health services worsen underlying health conditions, including endemic chronic infectious diseases such as HIV and tuberculosis. Furthermore, limited, and heterogeneous research was conducted to evaluate the indirect impact of the pandemic on general health services and on major diseases across African countries. International mitigation measures, such as resource reallocation, lockdowns, social restrictions, and fear from the population have had multi-sectoral impacts on various aspects of everyday life, that shaped the general health response. Despite the vast heterogeneity of data across African countries, available evidence suggests that the COVID-19 pandemic has severely impacted the control and prevention programs, the diagnosis capacity and the adherence to treatment of major infectious diseases (HIV, TB, and Malaria) - including neglected diseases - and non-communicable diseases. Future research and efforts are essential to deeply assess the medium- and long-term impact of the pandemic, and to implement tailored interventions to mitigate the standstill on decades of improvement on public health programs.
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Affiliation(s)
- Beatrice Formenti
- UNESCO Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia, Italy
| | - Natalia Gregori
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
| | | | - Francesco Castelli
- UNESCO Training and Empowering Human Resources for Health Development in Resource-Limited Countries, University of Brescia, Italy.,Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Italy
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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: 5] [Impact Index Per Article: 2.5] [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.
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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
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Wambua S, Malla L, Mbevi G, Kandiah J, Nwosu AP, Tuti T, Paton C, Wambu B, English M, Okiro EA. Quantifying the indirect impact of COVID-19 pandemic on utilisation of outpatient and immunisation services in Kenya: a longitudinal study using interrupted time series analysis. BMJ Open 2022; 12:e055815. [PMID: 35273053 PMCID: PMC8914407 DOI: 10.1136/bmjopen-2021-055815] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE In this study, we assess the indirect impact of COVID-19 on utilisation of immunisation and outpatient services in Kenya. DESIGN Longitudinal study. SETTING Data were analysed from all healthcare facilities reporting to Kenya's health information system from January 2018 to March 2021. Multiple imputation was used to address missing data, interrupted time series analysis was used to quantify the changes in utilisation of services and sensitivity analysis was carried out to assess robustness of estimates. EXPOSURE OF INTEREST COVID-19 outbreak and associated interventions. OUTCOME MEASURES Monthly attendance to health facilities. We assessed changes in immunisation and various outpatient services nationally. RESULTS Before the first case of COVID-19 and pursuant intervention measures in March 2020, uptake of health services was consistent with historical levels. There was significant drops in attendance (level changes) in April 2020 for overall outpatient visits for under-fives (rate ratio, RR 0.50, 95% CI 0.44 to 0.57), under-fives with pneumonia (RR 0.43, 95% CI 0.38 to 0.47), overall over-five visits (RR 0.65, 95% CI 0.57 to 0.75), over-fives with pneumonia (RR 0.62, 95% CI 0.55 to 0.70), fourth antenatal care visit (RR 0.86, 95% CI 0.80 to 0.93), total hypertension (RR 0.89, 95% CI 0.82 to 0.96), diabetes cases (RR 0.95 95% CI, 0.93 to 0.97) and HIV testing (RR 0.97, 95% CI 0.94 to 0.99). Immunisation services, first antenatal care visits, new cases of hypertension and diabetes were not affected. The post-COVID-19 trend was increasing, with more recent data suggesting reversal of effects and health services reverting to expected levels as of March 2021. CONCLUSION COVID-19 pandemic has had varied indirect effects on utilisation of health services in Kenya. There is need for proactive and targeted interventions to reverse these effects as part of the pandemic's response to avert non-COVID-19 indirect mortality.
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Affiliation(s)
- Steven Wambua
- Population Health Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Lucas Malla
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - George Mbevi
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Joel Kandiah
- Mathematics Institute, University of Warwick, Coventry, UK
| | - Amen-Patrick Nwosu
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
| | - Timothy Tuti
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Chris Paton
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
| | - Bernard Wambu
- Division of Neonatal and Child Health, Kenya Ministry of Health, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
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10
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Decline in Uptake of Childhood Vaccinations in a Tertiary Hospital in Northern Ghana during the COVID-19 Pandemic. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6995096. [PMID: 34926689 PMCID: PMC8672106 DOI: 10.1155/2021/6995096] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/11/2021] [Accepted: 11/20/2021] [Indexed: 02/08/2023]
Abstract
At the beginning of the COVID-19 pandemic, early modelling studies estimated a reduction in childhood vaccinations in low- and middle-income countries. Regular provision of both curative and preventive services such as antenatal care and childhood immunizations has been negatively affected since the onset of the pandemic. Our study was aimed at examining the impact that the pandemic had on childhood vaccination services at the Tamale Teaching Hospital (TTH). A mixed methods study design was employed for the study, which was conducted at the Child Welfare Clinic (CWC) of the TTH. With quantitative approach, we retrospectively looked at the uptake of the various vaccines during the pandemic era, defined as the period between 1st March 2020 and 28th February, 2021, and the prepandemic era defined as the period 1st March 2019 to 29th February, 2020. The qualitative approach was used to understand the perspective of five healthcare providers at the CWC and the four caregivers of children who have missed a vaccine or delayed in coming, on the factors accounting for any observed change. Data analysis was done using Microsoft Excel 2016 and thematic content analysis. Quantitative data were presented in frequencies, percentages, and line graphs. With the exception of the Measles Rubella (MR) 2 vaccine, we observed a decline ranging from 47% (2298) to 10.5% (116), with the greatest decline seen in the BCG and the least decline seen in the MR1 vaccine. The month of May 2020 saw the greatest decline, that is, 70.6% (813). A decline of 38.3% (4473) was noted when comparison was made between the designated prepandemic and pandemic eras, for all the vaccines in our study. Fear of COVID-19 infection and misinformation were commonly given as reasons for the decline. Catch-up immunization schedule should be instituted to curtail possible future outbreaks of vaccine-preventable diseases.
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11
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Ota MOC, Badur S, Romano-Mazzotti L, Friedland LR. Impact of COVID-19 pandemic on routine immunization. Ann Med 2021; 53:2286-2297. [PMID: 34854789 PMCID: PMC8648038 DOI: 10.1080/07853890.2021.2009128] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022] Open
Abstract
The current COVID-19 global pandemic continues to impact healthcare services beyond those directly related to the management of SARS-CoV-2 transmission and disease. We reviewed the published literature to assess the pandemic impact on existing global immunization activities and how the impact may be addressed. Widespread global disruption in routine childhood immunization has impacted a majority of regions and countries, especially in the initial pandemic phases. While data indicate subsequent recovery in immunization rates, a substantial number of vulnerable people remain unvaccinated. The downstream impact may be even greater in resource-limited settings and economically poorer populations, and consequently there are growing concerns around the resurgence of vaccine-preventable diseases, particularly measles. Guidance on how to address immunization deficits are available and continue to evolve, emphasizing the importance of maintaining and restoring routine immunization and necessary mass vaccination campaigns during and after pandemics. In this, collaboration between a broad range of stakeholders (governments, industry, healthcare decision-makers and frontline healthcare professionals) and clear communication and engagement with the public can help achieve these goals.Key messagesThe COVID-19 pandemic has a substantial impact on essential immunization activities.Disruption to mass vaccination campaigns increase risk of VPD resurgence.Catch-up campaigns are necessary to limit existing shortfalls in vaccine uptake.Guidance to mitigate these effects continues to evolve.
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12
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Burkholder B, Wadood Z, Kassem AM, Ehrhardt D, Zomahoun D. The immediate impact of the COVID-19 pandemic on polio immunization and surveillance activities. Vaccine 2021; 41 Suppl 1:A2-A11. [PMID: 34756614 PMCID: PMC8531002 DOI: 10.1016/j.vaccine.2021.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/23/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
In addition to affecting individual health the COVID-19 pandemic has disrupted efforts to deliver essential health services around the world. In this article we present an overview of the immediate programmatic and epidemiologic impact of the pandemic on polio eradication as well as the adaptive strategic and operational measures taken by the Global Polio Eradication Initiative (GPEI) from March through September 2020. Shortly after the World Health Organization (WHO) declared a global pandemic on 11 March 2020, the GPEI initially redirected the programme’s assets to tackle COVID-19 and suspended house-to-house supplementary immunization activities (SIAs) while also striving to continue essential poliovirus surveillance functions. From March to May 2020, 28 countries suspended a total of 62 polio vaccine SIAs. In spite of efforts to continue poliovirus surveillance, global acute flaccid paralysis (AFP) cases reported from January-July 2020 declined by 34% compared with the same period in 2019 along with decreases in the mean number of environment samples collected per active site in the critical areas of the African and Eastern Mediterranean regions. The GPEI recommended countries should resume planning and implementation of SIAs starting in July 2020 and released guidelines to ensure these could be done safely for front line workers and communities. By the end of September 2020, a total of 14 countries had implemented circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak response vaccination campaigns and Afghanistan and Pakistan restarted SIAs to stop ongoing wild poliovirus type 1 (WPV1) transmission. The longer-term impacts of disruptions to eradication efforts remain to be determined, especially in terms of the effect on poliovirus epidemiology. Adapting to the pandemic situation has imposed new considerations on program implementation and demonstrated not only GPEI’s contribution to global health security, but also identified potential opportunities for coordinated approaches across immunization and health services.
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Affiliation(s)
- Brent Burkholder
- Global Public Health Consultant, 834 Miller Drive, Davis, CA 95616, United States.
| | - Zubair Wadood
- WHO Polio Eradication Division, Avenue Appia 20, 1211 Geneva, Switzerland.
| | - Ahmed M Kassem
- Global Immunization Division, US Centers for Disease Control and Prevention, 1600 Clifton Road, NE Atlanta, GA 30333, United States.
| | - Derek Ehrhardt
- Global Immunization Division, US Centers for Disease Control and Prevention, 1600 Clifton Road, NE Atlanta, GA 30333, United States.
| | - Delayo Zomahoun
- WHO Polio Eradication Division, Avenue Appia 20, 1211 Geneva, Switzerland.
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13
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Shaikh N, Pelzer PT, Thysen SM, Roy P, Harris RC, White RG. Impact of COVID-19 Disruptions on Global BCG Coverage and Paediatric TB Mortality: A Modelling Study. Vaccines (Basel) 2021; 9:1228. [PMID: 34835161 PMCID: PMC8624525 DOI: 10.3390/vaccines9111228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022] Open
Abstract
The impact of COVID-19 disruptions on global Bacillus Calmette-Guérin (BCG) coverage and paediatric tuberculosis (TB) mortality is still unknown. To fill this evidence-gap and guide mitigation measures, we estimated the impact of COVID-19 disruptions on global BCG coverage and paediatric TB mortality. First, we used data from multiple sources to estimate COVID-19-disrupted BCG vaccination coverage. Second, using a static mathematical model, we estimated the number of additional paediatric TB deaths in the first 15 years of life due to delayed/missed vaccinations in 14 scenarios-varying in duration of disruption, and magnitude and timing of catch-up. We estimated a 25% reduction in global BCG coverage within the disruption period. The best-case scenario (3-month disruption, 100% catch-up within 3 months) resulted in an additional 886 (0.5%) paediatric TB deaths, and the worst-case scenario (6-month disruption with no catch-up) resulted in an additional 33,074 (17%) deaths. The magnitude of catch-up was found to be the most influential variable in minimising excess paediatric TB mortality. Our results show that ensuring catch-up vaccination of missed children is a critical priority, and delivery of BCG alongside other routine vaccines may be a feasible way to achieve catch-up. Urgent action is required to support countries with recovering vaccination coverages to minimise paediatric deaths.
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Affiliation(s)
- Nabila Shaikh
- TB Modelling Group, TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.C.H.); (R.G.W.)
| | - Puck T. Pelzer
- Technical Division, KNCV Tuberculosis, Maanweg 174, 2516 AB The Hague, The Netherlands;
| | - Sanne M. Thysen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2004 Frederiksberg, Denmark;
- Bandim Health Project, Apartado 861, Bissau 1004, Guinea-Bissau
| | - Partho Roy
- Immunisation and Countermeasures, National Infection Service, Public Health England, London NW9 5EQ, UK;
| | - Rebecca C. Harris
- TB Modelling Group, TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.C.H.); (R.G.W.)
- Sanofi Pasteur, South Beach Tower 18-11, Singapore 189767, Singapore
| | - Richard G. White
- TB Modelling Group, TB Centre, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (R.C.H.); (R.G.W.)
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14
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Masresha B, Luce R, Katsande R, Dosseh A, Tanifum P, Lebo E, Byabamazima C, Kfutwah A. The impact of the COVID-19 pandemic on measles surveillance in the World Health Organisation African Region, 2020. Pan Afr Med J 2021; 39:192. [PMID: 34603573 PMCID: PMC8464208 DOI: 10.11604/pamj.2021.39.192.29491] [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: 04/24/2021] [Accepted: 06/17/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction following the declaration of the COVID-19 pandemic, many countries imposed restrictions on public gatherings, health workers were repurposed for COVID-19 response, and public demand for preventive health services declined due to fear of getting COVID-19 in health care settings. These factors led to the disruption in health service delivery, including childhood immunization, in the first months of the pandemic. Measles surveillance supported with laboratory confirmation, is implemented in the African Region as part of the strategies towards attaining measles elimination. World Health Organisation developed guidelines to assist countries to continue to safely provide essential health services including immunization and the surveillance of vaccine preventable diseases during the pandemic. Methods we analysed the measles case-based surveillance and laboratory databases for the years 2014 to 2020, to determine the impact of the COVID-19 pandemic on measles surveillance, comparing the performance in 2020 against the preceding years. Results the weekly reporting of suspected measles cases declined starting in April 2020. Twelve countries had more than 50% decline in both the number of reported cases as well as in the number of specimens collected in 2020, as compared to the mean for the years 2014-2018. In 2020, only 30% of the specimens from suspected measles cases arrived at the national laboratory within 3 days of collection. At Regional level, 86% of the districts reported suspected measles cases in 2020, while the non-measles febrile rash illness rate was 2.1 per 100,000 population, which was the lowest rate documented since 2014. Only 11 countries met the targets for the two principal surveillance performance indicators in 2020 as compared to an average of 21 countries in the years 2014-2019. Conclusion the overall quality of measles surveillance has declined during the COVID pandemic in many countries. Countries should implement immediate and proactive measures to revitalise active surveillance for measles and monitor the quality of surveillance. We recommend that countries consider implementing specimen collection and testing methods that can facilitate timely confirmation of suspected measles cases in remote communities and areas with transportation challenges.
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Affiliation(s)
- Balcha Masresha
- World Health Organisation, Regional Office for Africa, Brazzaville, Congo
| | - Richard Luce
- World Health Organisation, Inter-Country Support Team for Western Africa, Ouagadougou, Burkina Faso
| | - Reggis Katsande
- World Health Organisation, Regional Office for Africa, Brazzaville, Congo
| | - Annick Dosseh
- World Health Organisation, Inter-Country Support Team for Western Africa, Ouagadougou, Burkina Faso
| | - Patricia Tanifum
- World Health Organisation, Inter-Country Support Team for Central Africa, Libreville, Gabon
| | - Emmaculate Lebo
- World Health Organisation, Inter-Country Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Charles Byabamazima
- World Health Organisation, Inter-Country Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Anfumbom Kfutwah
- World Health Organisation, Inter-Country Support Team for Central Africa, Libreville, Gabon
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15
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Burt JF, Ouma J, Lubyayi L, Amone A, Aol L, Sekikubo M, Nakimuli A, Nakabembe E, Mboizi R, Musoke P, Kyohere M, Namara Lugolobi E, Khalil A, Le Doare K. Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda. BMJ Glob Health 2021; 6:e006102. [PMID: 34452941 PMCID: PMC8406460 DOI: 10.1136/bmjgh-2021-006102] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/08/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND COVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals' movements in Uganda limited access to services. METHODS An observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019-March 2020), during (April 2020-June 2020) and after the national lockdown (July 2020-December 2020). RESULTS Between 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks.During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown. CONCLUSION The Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.
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Affiliation(s)
- Jessica Florence Burt
- School of Medicine, University of Leeds, Leeds, UK
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Joseph Ouma
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Lawrence Lubyayi
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
| | - Alexander Amone
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Lorna Aol
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Musa Sekikubo
- Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Annettee Nakimuli
- Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Eve Nakabembe
- Obstetrics and Gynecology, Makerere University and Mulago National Referral Hospital, Kampala, Uganda
| | - Robert Mboizi
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Philippa Musoke
- Makerere University Johns Hopkins University, Kampala, Uganda
| | - Mary Kyohere
- Makerere University Johns Hopkins University, Kampala, Uganda
| | | | - Asma Khalil
- Infection and Immunity, St. George's, University of London, London, UK
| | - Kirsty Le Doare
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Wakiso, Uganda
- Infection and Immunity, St. George's, University of London, London, UK
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16
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Nachega JB, Kapata N, Sam-Agudu NA, Decloedt EH, Katoto PDMC, Nagu T, Mwaba P, Yeboah-Manu D, Chanda-Kapata P, Ntoumi F, Geng EH, Zumla A. Minimizing the impact of the triple burden of COVID-19, tuberculosis and HIV on health services in sub-Saharan Africa. Int J Infect Dis 2021; 113 Suppl 1:S16-S21. [PMID: 33757874 PMCID: PMC7980520 DOI: 10.1016/j.ijid.2021.03.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 02/08/2023] Open
Abstract
In this perspective, we discuss the impact of COVID-19 on tuberculosis (TB)/HIV health services and approaches to mitigating the growing burden of these three colliding epidemics in sub-Saharan Africa (SSA). SSA countries bear significantly high proportions of TB and HIV cases reported worldwide, compared to countries in the West. Whilst COVID-19 epidemiology appears to vary across Africa, most countries in this region have reported relatively lower-case counts compared to the West. Nevertheless, the COVID-19 pandemic has added an additional burden to already overstretched health systems in SSA, which, among other things, have been focused on the longstanding dual epidemics of TB and HIV. As with these dual epidemics, inadequate resources and poor case identification and reporting may be contributing to underestimations of the COVID-19 case burden in SSA. Modelling studies predict that the pandemic-related disruptions in TB and HIV services will result in significant increases in associated morbidity and mortality over the next five years. Furthermore, limited empirical evidence suggests that SARS-CoV-2 coinfections with TB and HIV are associated with increased mortality risk in SSA. However, predictive models require a better evidence-base to accurately define the impact of COVID-19, not only on communicable diseases such as TB and HIV, but on non-communicable disease comorbidities. Further research is needed to assess morbidity and mortality data among both adults and children across the African continent, paying attention to geographic disparities, as well as the clinical and socio-economic determinants of COVID-19 in the setting of TB and/or HIV.
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Affiliation(s)
- Jean B Nachega
- Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa; Department of Epidemiology, Infectious Diseases and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nathan Kapata
- Zambia National Public Health Institute, University of Zambia-University College London Medical School Research and Training Project, University Teaching Hospital, Ministry of Health, Lusaka, Zambia.
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria; Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA; Department of Pediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Eric H Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
| | - Patrick D M C Katoto
- Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
| | - Tumaini Nagu
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
| | - Peter Mwaba
- Lusaka Apex Medical University, Lusaka, Zambia.
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| | | | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, and Center for Dissemination and Implementation, Institute for Public Health, Washington University, St Louis, Missouri, USA.
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals, London, UK.
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Bello IM, Lebo E, Shibeshi ME, Akpan GU, Chakauya J, Masresha BG, Daniel F. Implementation of integrated supportive supervision in the context of coronavirus 19 pandemic: its effects on routine immunization and vaccine preventable surveillance diseases indicators in the East and Southern African countries. Pan Afr Med J 2021; 38:164. [PMID: 33995771 PMCID: PMC8077641 DOI: 10.11604/pamj.2021.38.164.27349] [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: 12/09/2020] [Accepted: 02/05/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction the coronavirus disease (COVID-19) global pandemic has caused serious disruption to almost all aspect of human endeavor forcing countries to implement unprecedented public health measures aimed at mitigating its effects, such as total lockdown (inter and intra), travel bans, quarantine, social distancing in an effort to contain the spread of the virus. Supportive supervision is a functional component of the immunization systems that allows identification of existing gaps, provides an opportunity for onsite training, and document real-time findings for improvement of the program. The control measures of COVID-19 pandemic have also resulted in limitation of operations of the immunization system including supportive supervision. This has limited many aspects of supportive supervision for surveillance and routine immunization monitoring system in the East and Southern African countries. The aim of this study is to identify the effects of COVID-19 on Integrated Supportive Supervision visits for expanded programme on immunization (EPI) and how it influences the immunization and vaccine preventable disease (VPD) surveillance indicators, and its short-term effect towards notification of increase or decrease morbidity and mortality. Methods we reviewed the integrated supportive supervision (ISS) data and the routine administrative coverage from 19 countries in the East and Southern Africa (ESA) for the period January to August 2019 to analyze the trends in the number of visits, vaccine-preventable diseases (VPD), and routine immunization (RI) indicators using t-test, and compare with the period January to August 2020 during the months of the COVID-19 pandemic. Results thirteen countries out of the 19 considered, had shown a decline in the number of integrated supportive supervision (ISS) visits, with 10 (77%) having more than 59% decrease during the January-August 2020 as compared to the same period 2019. Eleven (57%) of the countries have shown a decrease (p-value < 0.05). Ethiopia and Kenya had the highest drop (p-value < 0.000). Six (32%) had an increase in the number of visits, with Madagascar, Zambia, and Zimbabwe having >100% increase in the number of visits. Sixty-seven percent (67%) of the countries that have decreased in the number of ISS visits have equally witnessed a drop in DPT3 administrative coverage. Countries with a low proportion of outreach sessions conducted in the period of January - August 2020, have all had sessions interruption, with more than 40% of the reasons associated with the lockdown. Conclusion countries have experienced a decrease in the number of supportive supervision visits conducted, during the period of the COVID-19 pandemic and, this has influenced the routine immunization and vaccine-preventable diseases surveillance (VPD) process indicators monitored through the conduct of the visits. Continuous decrease in these performance indicators pose a great threat to the performance sustained and the functionality of the surveillance and immunization system, and consequently on increased surveillance sensitivity to promptly detect outbreaks and aiming to reducing morbidity and mortality in the sub-region.
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Affiliation(s)
- Isah Mohammed Bello
- World Health Organization, Inter-Country Support Team Office for East and Southern Africa, P.O. Box 5160, Harare, Zimbabwe
| | - Emmaculate Lebo
- World Health Organization, Inter-Country Support Team Office for East and Southern Africa, P.O. Box 5160, Harare, Zimbabwe
| | - Messeret Eshetu Shibeshi
- World Health Organization, Inter-Country Support Team Office for East and Southern Africa, P.O. Box 5160, Harare, Zimbabwe
| | - Godwin Ubong Akpan
- World Health Organization, Regional Office for Africa, Cité du Djoué, Brazzaville, Congo
| | - Jethro Chakauya
- World Health Organization, Inter-Country Support Team Office for East and Southern Africa, P.O. Box 5160, Harare, Zimbabwe
| | - Balcha Girma Masresha
- World Health Organization, Regional Office for Africa, Cité du Djoué, Brazzaville, Congo
| | - Fussum Daniel
- World Health Organization, Inter-Country Support Team Office for East and Southern Africa, P.O. Box 5160, Harare, Zimbabwe
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18
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Nigus M, Zelalem M, Abraham K, Shiferaw A, Admassu M, Masresha B. Implementing nationwide measles supplemental immunization activities in Ethiopia in the context of COVID-19: process and lessons learnt. Pan Afr Med J 2020; 37:36. [PMID: 33456660 PMCID: PMC7796832 DOI: 10.11604/pamj.supp.2020.37.36.26614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/13/2020] [Indexed: 11/11/2022] Open
Abstract
The COVID-19 pandemic has disrupted immunization activities in many countries, causing declines in the delivery of routine doses of antigens, and the postponement of scheduled supplemental immunization activities (SIAs). Following the declaration of the pandemic, Ethiopia postponed nationwide follow-up measles preventive vaccination campaign which was scheduled for April 2020. The disruptions to routine services and the postponement of the SIAs increased the risk for measles outbreaks. The national authorities, in consultation with the secretariat of the National COVID-19 Pandemic Prevention and Control Ministerial Coordination Committee, subnational level authorities, technical partner agencies and stakeholders, reviewed the risks for measles outbreaks and decided to implement the nationwide measles SIAs, with strict implementation of COVID prevention measures. The revised micro-plans accommodated the additional human resource and logistics needs for COVID prevention, for which partner resources were mobilized to fill the gaps. The key SIAs preparatory and implementation activities including training, logistics, social mobilization, service delivery and supervision were modified to take into consideration the COVID context. Infection prevention and control supplies were procured and distributed as a package with the bundled vaccines and other supplies. The SIAs were completed in July 2020 and reached 102.8% administrative coverage nationwide, with 78% of the 1123 woredas attaining the target of 95% coverage. The strong commitment of the leadership, the coordination role of the national and regional COVID prevention and control taskforces, the engagement of community leaders, the use of multi-channel communication, the timely availability of additional resources and modification of the service delivery approaches contributed to the success of the SIAs.
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Affiliation(s)
- Mulat Nigus
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Amsalu Shiferaw
- United Nations Children's Fund (UNICEF), Addis Ababa, Ethiopia
| | | | - Balcha Masresha
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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19
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Nigus M, Zelalem M, Abraham K, Shiferaw A, Admassu M, Masresha B. Implementing nationwide measles supplemental immunization activities in Ethiopia in the context of COVID-19: process and lessons learnt. Pan Afr Med J 2020. [PMID: 33456660 PMCID: PMC7796832 DOI: 10.11604/pamj.supp.2020.37.1.26614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The COVID-19 pandemic has disrupted immunization activities in many countries, causing declines in the delivery of routine doses of antigens, and the postponement of scheduled supplemental immunization activities (SIAs). Following the declaration of the pandemic, Ethiopia postponed nationwide follow-up measles preventive vaccination campaign which was scheduled for April 2020. The disruptions to routine services and the postponement of the SIAs increased the risk for measles outbreaks. The national authorities, in consultation with the secretariat of the National COVID-19 Pandemic Prevention and Control Ministerial Coordination Committee, subnational level authorities, technical partner agencies and stakeholders, reviewed the risks for measles outbreaks and decided to implement the nationwide measles SIAs, with strict implementation of COVID prevention measures. The revised micro-plans accommodated the additional human resource and logistics needs for COVID prevention, for which partner resources were mobilized to fill the gaps. The key SIAs preparatory and implementation activities including training, logistics, social mobilization, service delivery and supervision were modified to take into consideration the COVID context. Infection prevention and control supplies were procured and distributed as a package with the bundled vaccines and other supplies. The SIAs were completed in July 2020 and reached 102.8% administrative coverage nationwide, with 78% of the 1123 woredas attaining the target of 95% coverage. The strong commitment of the leadership, the coordination role of the national and regional COVID prevention and control taskforces, the engagement of community leaders, the use of multi-channel communication, the timely availability of additional resources and modification of the service delivery approaches contributed to the success of the SIAs.
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Affiliation(s)
- Mulat Nigus
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Amsalu Shiferaw
- United Nations Children's Fund (UNICEF), Addis Ababa, Ethiopia
| | | | - Balcha Masresha
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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