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Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data.
Vaccine. 2020 10 21; 38(45):7146-7155.V

Abstract

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 to explore the predictors associated with immunizations during the lockdown.

RESULTS

There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Cal-mette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, 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 having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program.

CONCLUSION

One out of every two children in Sindh province has 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.

Authors+Show Affiliations

IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA. Electronic address: subhash.chandir@ird.global.IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore.IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan.Gavi, the Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland.IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan.IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan.Gavi, the Vaccine Alliance, Chemin du Pommier 40, 1218 Le Grand-Saconnex, Switzerland.IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan; Global Health Directorate, Indus Health Network, 5th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan.IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan.IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan.IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan; Global Health Directorate, Indus Health Network, 5th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan.IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan.IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32943265

Citation

Chandir, Subhash, et al. "Impact of COVID-19 Pandemic Response On Uptake of Routine Immunizations in Sindh, Pakistan: an Analysis of Provincial Electronic Immunization Registry Data." Vaccine, vol. 38, no. 45, 2020, pp. 7146-7155.
Chandir S, Siddiqi DA, Mehmood M, et al. Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data. Vaccine. 2020;38(45):7146-7155.
Chandir, S., Siddiqi, D. A., Mehmood, M., Setayesh, H., Siddique, M., Mirza, A., Soundardjee, R., Dharma, V. K., Shah, M. T., Abdullah, S., Akhter, M. A., Ali Khan, A., & Khan, A. J. (2020). Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data. Vaccine, 38(45), 7146-7155. https://doi.org/10.1016/j.vaccine.2020.08.019
Chandir S, et al. Impact of COVID-19 Pandemic Response On Uptake of Routine Immunizations in Sindh, Pakistan: an Analysis of Provincial Electronic Immunization Registry Data. Vaccine. 2020 10 21;38(45):7146-7155. PubMed PMID: 32943265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data. AU - Chandir,Subhash, AU - Siddiqi,Danya Arif, AU - Mehmood,Mariam, AU - Setayesh,Hamidreza, AU - Siddique,Muhammad, AU - Mirza,Amna, AU - Soundardjee,Riswana, AU - Dharma,Vijay Kumar, AU - Shah,Mubarak Taighoon, AU - Abdullah,Sara, AU - Akhter,Mohammed Adil, AU - Ali Khan,Anokhi, AU - Khan,Aamir Javed, Y1 - 2020/08/15/ PY - 2020/05/13/received PY - 2020/08/07/revised PY - 2020/08/09/accepted PY - 2020/9/19/pubmed PY - 2020/10/23/medline PY - 2020/9/18/entrez KW - COVID-19 KW - Electronic Immunization Registry KW - Immunization coverage KW - Predictors of immunization KW - mHealth SP - 7146 EP - 7155 JF - Vaccine JO - Vaccine VL - 38 IS - 45 N2 - 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 to explore the predictors associated with immunizations during the lockdown. RESULTS: There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Cal-mette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, 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 having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program. CONCLUSION: One out of every two children in Sindh province has 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. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/32943265/Impact_of_COVID_19_pandemic_response_on_uptake_of_routine_immunizations_in_Sindh_Pakistan:_An_analysis_of_provincial_electronic_immunization_registry_data_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(20)31050-1 DB - PRIME DP - Unbound Medicine ER -