Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 24;11(9):1415.
doi: 10.3390/vaccines11091415.

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

George Mwinnyaa  1 , Michael A Peters  2 , Gil Shapira  2 , Rachel Neill  1 , Husnia Sadat  1 , Sylvain Yuma  3 , Pierre Akilimali  4 , Shahadat Hossain  5 , Naod Wendrad  6 , Wisdom K Atiwoto  7 , Anthony Adofo Ofosu  8 , Jean Patrick Alfred  9 , Helen Kiarie  10 , Chea Sanford Wesseh  11 , Chris Isokpunwu  12 , Desmond Maada Kangbai  13 , Abdifatah Ahmed Mohamed  14 , Kadidja Sidibe  1 , Salome' Drouard  2 , Pablo Amor Fernandez  2 , Viviane Azais  1 , Tawab Hashemi  1 , Peter M Hansen  1 , Tashrik Ahmed  1
Affiliations

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

George Mwinnyaa et al. Vaccines (Basel). .

Abstract

Background: During and after the SARS-CoV-2 (COVID-19) pandemic, many countries experienced declines in immunization that have not fully recovered to pre-pandemic levels. This study uses routine health facility immunization data to estimate variability between and within countries in post-pandemic immunization service recovery for BCG, DPT1, and DPT3.

Methods: After adjusting for data reporting completeness and outliers, interrupted time series regression was used to estimate the expected immunization service volume for each subnational unit, using an interruption point of March 2020. We assessed and compared the percent deviation of observed immunizations from the expected service volume for March 2020 between and within countries.

Results: Six countries experienced significant service volume declines for at least one vaccine as of October 2022. The shortfall in BCG service volume was ~6% (95% CI -1.2%, -9.8%) in Guinea and ~19% (95% CI -16%, 22%) in Liberia. Significant cumulative shortfalls in DPT1 service volume are observed in Afghanistan (-4%, 95% CI -1%, -7%), Ghana (-3%, 95% CI -1%, -5%), Haiti (-7%, 95% CI -1%, -12%), and Kenya (-3%, 95% CI -1%, -4%). Afghanistan has the highest percentage of subnational units reporting a shortfall of 5% or higher in DPT1 service volume (85% in 2021 Q1 and 79% in 2020 Q4), followed by Bangladesh (2020 Q1, 83%), Haiti (80% in 2020 Q2), and Ghana (2022 Q2, 75%). All subnational units in Bangladesh experienced a 5% or higher shortfall in DPT3 service volume in the second quarter of 2020. In Haiti, 80% of the subnational units experienced a 5% or higher reduction in DPT3 service volume in the second quarter of 2020 and the third quarter of 2022.

Conclusions: At least one region in every country has a significantly lower-than-expected post-pandemic cumulative volume for at least one of the three vaccines. Subnational monitoring of immunization service volumes using disaggregated routine health facility information data should be conducted routinely to target the limited vaccination resources to subnational units with the highest inequities.

Keywords: child health; health inequalities; health systems; immunization; routine data.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Percent change in immunization service volumes from expected levels based on pre-pandemic trends in 12 countries for BCG, DPT1, and DPT33 from March 2020 to October 2022 (β, 95% CI).
Figure 2
Figure 2
Percent change in immunization service volumes from expected levels based on pre-pandemic trends in 12 countries for BCG, DPT1, and DPT3, by subnational units, from March 2020 to October 2022.
Figure 3
Figure 3
Percent of subnational units with more than 5% shortfall for BCG, DPT1, and DPT3 in 12 countries from March 2020 to October 2022.
See this image and copyright information in PMC

References

    1. Rappuoli R., Pizza M., Del Giudice G., De Gregorio E. Vaccines, new opportunities for a new society. Proc. Natl. Acad. Sci. USA. 2014;111:12288–12293. doi: 10.1073/pnas.1402981111. - DOI - PMC - PubMed
    1. Greenwood B. The contribution of vaccination to global health: Past, present and future. Philos. Trans. R. Soc. B Biol. Sci. 2014;369:20130433. doi: 10.1098/rstb.2013.0433. - DOI - PMC - PubMed
    1. World Health Organization . Vaccines and Immunization [internet] World Health Organization; Geneva, Switzerland: 2023.
    1. Ahmed T., Roberton T., Vergeer P., Hansen P.M., Peters M.A., Ofosu A.A., Mwansambo C., Nzelu C., Wesseh C.S., Smart F., et al. Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low-and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data. PloS Med. 2022;19:e1004070. doi: 10.1371/journal.pmed.1004070. - DOI - PMC - PubMed
    1. Dzinamarira T., Moyo E., Moyo P., Pierre G., Mpabuka E., Kahere M., Tungwarara N., Chitungo I., Murewanhema G., Musuka G. Childhood immunization services accessibility and utilization during the COVID-19 pandemic in Africa. J. Infect. 2022;85:436–480. doi: 10.1016/j.jinf.2022.07.020. - DOI - PMC - PubMed

LinkOut - more resources