Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data

Autor: Danya Arif Siddiqi, Muhammad Siddique, Amna Mirza, Riswana Soundardjee, Hamidreza Setayesh, Subhash Chandir, A J Khan, Sara Abdullah, Mariam Mehmood, Mubarak Taighoon Shah, Vijay Kumar Dharma, Mohammed Adil Akhter, Anokhi Ali Khan
Rok vydání: 2020
Předmět:
Male
Rural Population
Vaccination Coverage
Urban Population
Immunization registry
Logistic regression
Electronic Immunization Registry
0302 clinical medicine
Health care
Pandemic
Medicine
Pakistan
030212 general & internal medicine
Registries
education.field_of_study
Vaccination
Infectious Diseases
Quarantine
BCG Vaccine
Molecular Medicine
Female
Coronavirus Infections
Coronavirus disease 2019 (COVID-19)
030231 tropical medicine
Population
Measles Vaccine
Pneumonia
Viral
Vaccines
Attenuated
Article
Rotavirus Infections
Predictors of immunization
03 medical and health sciences
Betacoronavirus
Humans
education
Pandemics
Tuberculosis
Pulmonary
Electronic Data Processing
General Veterinary
General Immunology and Microbiology
Immunization coverage
business.industry
Immunization Programs
SARS-CoV-2
Public Health
Environmental and Occupational Health
Infant
Newborn
Rotavirus Vaccines
COVID-19
Infant
biochemical phenomena
metabolism
and nutrition
Immunization
business
Demography
Measles
Zdroj: Vaccine
ISSN: 1873-2518
Popis: Highlights • Three out of five children in Sindh province have missed their routine vaccinations during COVID-19 lockdown. • Around 9,469 children/day were missing immunization during the lockdown. • Enrollment into immunziation declined furthest in rural districts, and urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. • The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. • Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.
Background COVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan. Methods We extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression methods to explore the predictors associated with immunizations during the lockdown. Results There was a 51.0% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Calmette-Guerin (BCG) (40.6% (958/2,360) immunization at fixed sites. Around 8,438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, and urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI 1.04 – 1.15) and those with mothers who had higher education (RR: 1.19 – 1.50; 95% CI: 1.13 – 1.65). Likelihood of penta-3 coverage was reduced by 5% for each week of delayed enrollment into immunization. Conclusion One out of every two children in Sindh province have missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.
Databáze: OpenAIRE
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