Attendance and vaccination at immunization clinics in rural Gambia before and during the COVID-19 pandemic

Osei, Isaac; Sarwar, Golam; Hossain, Ilias; Sonko, Kemo; Ceesay, Lamin; Baldeh, Bubacarr; Secka, Ebba; Mackenzie, Grant

doi:10.1016/j.vaccine.2022.09.031

Cited by 14 publications

(33 citation statements)

References 18 publications

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“…Our findings differ in some respects from those of the only other study from The Gambia that has so far explored the impact of the pandemic on vaccination services delivery. In contrast to our findings, the previous study reported reduced clinic visits and vaccination doses administered, particularly for birth doses, for only 3 months after the onset of the pandemic in The Gambia compared with the baseline period 45. Although the previous study also reported data from BHDSS, which is one of our study sites, slight differences in the objectives and methodology of the two studies could explain the differences in findings.…”

Section: Discussioncontrasting

confidence: 99%

“…While we did not examine doses given in later infancy, we can likely extrapolate the likely impact due to the fact that we used sensitive markers (timeliness and birth doses of vaccines). We do not anticipate widely varying outcomes, given that the only previous study from The Gambia showed that clinic visits for vaccines given in later infancy were minimally impacted 45…”

Section: Discussionmentioning

confidence: 97%

“…The guideline mandated the continuation of immunisation delivery at outreach vaccination sites,43 a key strategy for delivering routine vaccines that have contributed to the success of the immunisation programme in The Gambia 44. To reduce waiting time and avoid overcrowding at clinics, some ancillary activities were temporarily suspended during vaccination activities conducted in health facilities (fixed-clinics) until late 2020 45. These activities included child weight measurement and updating of daily records logbooks, except for recording information on hand-held vaccination cards.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015–2021

Wariri,

Utazi,

Okomo

et al. 2023

BMJ Glob Health

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IntroductionThe 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.MethodsWe 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.ResultWe 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.ConclusionDespite 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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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015–2021

Wariri,

Utazi,

Okomo

et al. 2023

BMJ Glob Health

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“…The Ministry of Health’s annual service statistics report revealed that, overall, there was a slightly higher proportion of institutional deliveries in 2020 than 2019 (96.5% vs 94.8%) [ 43 ]. Since this study included children captured in the health facility immunization registers, it is possible that some eligible children were missed, especially taking into account the impact of the Covid-19 pandemic on routine immunization [ 44 ]. Including the potentially missed children could raise or decrease timeliness rates depending on their time to hepatitis B vaccination.…”

Section: Discussionmentioning

confidence: 99%

Impact of a performance monitoring intervention on the timeliness of Hepatitis B birth dose vaccination in the Gambia: a controlled interrupted time series analysis

et al. 2023

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Introduction The Hepatitis B virus that can cause liver cancer is highly prevalent in the Gambia, with one in ten babies at risk of infection from their mothers. Timely hepatitis B birth dose administration to protect babies is very low in The Gambia. Our study assessed whether 1) a timeliness monitoring intervention resulted in hepatitis B birth dose timeliness improvements overall, and 2) the intervention impacted differentially among health facilities with different pre-intervention performances. Methods We used a controlled interrupted time series design including 16 intervention health facilities and 13 matched controls monitored from February 2019 to December 2020. The intervention comprised a monthly hepatitis B timeliness performance indicator sent to health workers via SMS and subsequent performance plotting on a chart. Analysis was done on the total sample and stratified by pre-intervention performance trend. Results Overall, birth dose timeliness improved in the intervention compared to control health facilities. This intervention impact was, however, dependent on pre-intervention health facility performance, with large impact among poorly performing facilities, and with uncertain moderate and weak impacts among moderately and strongly performing facilities, respectively. Conclusion The implementation of a novel hepatitis B vaccination timeliness monitoring system in health facilities led to overall improvements in both immediate timeliness rate and trend, and was especially helpful in poorly performing health facilities. These findings highlight the overall effectiveness of the intervention in a low-income setting, and also its usefulness to aid facilities in greatest need of improvement.

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“…Also, rumours of unauthorised testing of COVID-19 vaccines caused some concern in the community but were strongly refuted by Government agencies. Attendance at RCH/EPI clinics was substantially reduced in the months of April, July, and August, but with subsequent rapid return to normal attendance and recovery of antigen delivery to the infant population [11]. Upon resumption of trial activities at RCH/EPI clinics eld staff were at physically separate locations, with physical distance, masks, and hand hygiene.…”

Section: Delivery Of the Interventionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on a clinical trial of pneumococcal vaccine scheduling (PVS) in rural Gambia

Hossain

Osei

Lobga

et al. 2022

Preprint

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The COVID-19 pandemic represents an unprecedented challenge for clinical research. The Pneumococcal Vaccine Schedules (PVS) study is a non-inferiority, interventional trial in which infants resident in 68 geographic clusters are randomised to two different schedules for pneumococcal vaccination. From September 2019 onwards, all infants resident in the study area became eligible for trial enrolment at all Expanded Programme on Immunisation (EPI) clinics in the study area. Surveillance for clinical endpoints is conducted at all 11 health facilities in the study area. PVS is conducted as a collaboration between the Medical Research Council Unit The Gambia (MRCG) at LSHTM and the Gambian Ministry of Health (MoH). The COVID-19 pandemic caused many disruptions to PVS. MRCG instructed interventional studies that participant enrolment be suspended on 26 March 2020 and a public health emergency was declared in The Gambia on 28 March 2020. Enrolment in PVS restarted on 1 July 2020, was suspended again on 5 August 2020 after The Gambia experienced a sharp increase in COVID-19 cases in late July 2020 and restarted again on 1 September 2020.. During periods of suspended enrolment of infants at EPI clinics PVS continued safety surveillance at health facilities, albeit with disruptions. During the periods of suspended enrolment infants who had been enrolled before 26 March 2020 continued to receive the PCV schedule to which they had been randomly allocated based on their village of residence, whereas all other infants received the standard PCV schedule. Throughout 2020 and 2021 the trial faced numerous technical and operational challenges; disruption to MoH delivery of EPI services and clinical care at health facilities, episodes of staff illness and isolation, disruption of MRCG transport, procurement, communications, human resource management, and also a range of ethical, regulatory, sponsorship, trial monitoring, and financial challenges. In April 2021 a formal review concluded that the pandemic had not compromised the scientific validity of PVS and that the trial should continue as per protocol. The continuing challenges that COVID-19 poses to PVS and other clinical trials will persist for some time.

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Attendance and vaccination at immunization clinics in rural Gambia before and during the COVID-19 pandemic

Cited by 14 publications

References 18 publications

Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015–2021

Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015–2021

Impact of a performance monitoring intervention on the timeliness of Hepatitis B birth dose vaccination in the Gambia: a controlled interrupted time series analysis

Impact of the COVID-19 pandemic on a clinical trial of pneumococcal vaccine scheduling (PVS) in rural Gambia

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