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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nkereuwem E, Agbla S, Sallahdeen A, Owolabi O, Sillah AK, Genekah M, Tunkara A, Kandeh S, Jawara M, Saidy L, Bush A, Togun T, Kampmann B. Reduced lung function and health-related quality of life after treatment for pulmonary tuberculosis in Gambian children: a cross-sectional comparative study. Thorax 2023; 78:281-287. [PMID: 36109164 PMCID: PMC9985734 DOI: 10.1136/thorax-2022-219085] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Post-tuberculosis (post-TB) lung disease is an under-recognised consequence of pulmonary tuberculosis (pTB). We aimed to estimate the prevalence of residual lung function impairment and reduced health-related quality of life (HRQoL) in children after pTB treatment completion. METHODS We conducted a cross-sectional comparative study of children aged less than 15 years at TB diagnosis who had completed treatment for pTB at least 6 months previously with a comparator group of age-matched children without a history of pTB. Symptoms, spirometry and HRQoL measured with PedsQL scale were collected. Variables associated with lung function impairment were identified through logistic regression models. RESULTS We enrolled 68 post-TB cases (median age 8.9 (IQR 7.2-11.2) years) and 91 children in the comparison group (11.5 (8.0-13.7) years). Spirometry from 52 (76.5%) post-TB cases and 89 (94.5%) of the comparison group met the quality criteria for acceptability and repeatability. Lung function impairment was present in 20/52 (38.5%) post-TB cases and 15/86 (17.4%) in the comparison group, p=0.009. Previous pTB and a history of chronic cough were significantly associated with the presence of lung function impairment (p=0.047 and 0.006 respectively). Forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC z-scores were significantly lower in the post-TB cases compared with the comparison group (p= <0.001, 0.014 and <0.001, respectively). The distribution of the self-reported physical health score, and parent-reported physical, emotional, psychological, social and total HRQoL scores were significantly lower in the post-TB cases compared with the comparison group. CONCLUSIONS Previous TB in children is associated with significantly impaired lung function and HRQoL.
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Affiliation(s)
- Esin Nkereuwem
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia .,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Schadrac Agbla
- Department of Health Data Science, University of Liverpool, Liverpool, UK.,Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Azeezat Sallahdeen
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Olumuyiwa Owolabi
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Abdou K Sillah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Monica Genekah
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Abdoulie Tunkara
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Sheriff Kandeh
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Maryama Jawara
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Lamin Saidy
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, National Heart & Lung Institute, Imperial College London - Royal Brompton Campus, London, UK.,Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Toyin Togun
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Beate Kampmann
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Vaccine Centre, London School of Hygiene & Tropical Medicine, London, UK
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