Changes in Childhood Immunizations and Intermittent Preventive Malaria Treatment in a Peripheral, Referral Immunization Center During the First 12 Months of COVID-19 Pandemic in Sierra Leone, Western Africa

Abstract

BackgroundThere is increasing evidence that the COVID-19 pandemic disrupted childhood immunization services. However, detailed reports on immunizations and preventive antimalarial prophylactic treatments delivered and how the trends changed in referral centers in low-income countries are still missing.MethodsWe performed a retrospective cross-sectional study. Data for vaccinations administered to children <5 years of age, according to the local vaccination schedule, were extracted from the official records of the Kent Community Health Post, Sierra Leone, in the period between April 2019 and March 2021. We compared the vaccinations performed in the first year, considered as a pre-Covid period, with the second year, post-Covid period. Both the period was then divided in four trimester each and the same analysis was operated for each trimester. A Chi-square goodness of fit test was performed to compare the number of vaccinations performed both in the 2 years and in the 8 trimesters.FindingsSeven thousand two hundred and eighty-three vaccinations were administered: 4,641 in the period between April 2019 and March 2020 and 2,642 between April 2020 and March 2021. The drop in immunizations performed began as soon as the first cases were described in China. The drops were statistically significant when the first three trimesters of the two study periods were compared, while no statistically significant differences were observed for all the vaccines performed in the 4th trimesters. Vaccines administered at birth (BCG) were less affected compared to booster vaccinations.ConclusionsImmunizations administered in a referral health center in Sierra Leone significantly declined during the pandemic. Although the decline was less pronounced in the last months of the pandemic, we don't think that the small increase would indicate the recovery of previously missed vaccinations. These findings open new public health challenges for the coming years.

Vaccination Utilization and Subnational Inequities during the COVID-19 Pandemic: An Interrupted Time-Series Analysis of Administrative Data across 12 Low- and Middle-Income Countries

“…As volatile subregions become the center of attention for monitoring immunization programs, disaggregating results by subnational areas must become standard practice. Our national-level results align with previously published studies on immunization service disruption and recovery trends during the COVID-19 pandemic [ 42 , 43 , 44 , 45 ]. However, our study, unlike other studies [ 42 , 44 ], further demonstrates that the national immunization trends do not necessarily mirror the subnational trends.…”

“…Our national-level results align with previously published studies on immunization service disruption and recovery trends during the COVID-19 pandemic [ 42 , 43 , 44 , 45 ]. However, our study, unlike other studies [ 42 , 44 ], further demonstrates that the national immunization trends do not necessarily mirror the subnational trends. This phenomenon may similarly explain why countries with high administrative MCV1 coverage estimates experience high measles outbreaks in some subnational units [ 46 , 47 , 48 , 49 , 50 ].…”

Disruptions to routine childhood vaccinations in low- and middle-income countries during the COVID-19 pandemic: A systematic review

“…One study from Sierra Leone has since published data on vaccination declines until March 2021 by quarter. This dynamic analysis showed that despite improvements in vaccination levels in every quarter, most vaccines continued to show declines of over 10% by March 2021 ( 68 ). If recovery is greater in HICs than LMICs, these findings raise concern over potential widening of global inequalities in vaccination ( 13 ).…”

Assessing the hidden burden and costs of COVID-19 pandemic in South Asia: Implications for health and well-being of women, children and adolescents

“…Evidence from past crises, such as the 1997 East Asian financial crisis, the 2008 global financial and food price increase crises, and the 2013-16 Ebola outbreak in West Africa, underscore the vulnerability of women and children, through reduced access to antenatal care, immunizations and schooling [5][6][7][8][9][10]. Evidence from the COVID-19 pandemic paints a similar picture, including deferral or non-receipt of antenatal care visits due to lockdowns and lack of transport, decrease in facility-based deliveries, and child growth monitoring and immunizations by up to 50%, especially in the early months of the pandemic [11][12][13][14][15][16].…”