Unveiling the dimension of regional disparities: Assessing the disruption of immunisation services by COVID-19 in Bangladesh.

IF 4.5 3区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Journal of Global Health Pub Date : 2024-10-25 DOI:10.7189/jogh.14.05028
Ema Akter, Abu Sayeed, Abu Bakkar Siddique, Bibek Ahamed, Ridwana Maher Manna, Lubna Hossain, K M Tanvir, Md Ariful Islam Sanim, Md Hafizur Rahman, Srizan Chowdhury, Tasnu Ara, Md Alamgir Hossain, M Sabbir Haider, Sabrina Jabeen, Shafiqul Ameen, Mohammad Sohel Shomik, Anisuddin Ahmed, Luis Huicho, Alicia Matijasevich, Abdoulaye Maiga, Ahmed Ehsanur Rahman, Nadia Akseer, Shams El Arifeen, Aniqa Tasnim Hossain, Agbessi Amouzou
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Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted essential health care services worldwide, including those related to immunisation. National data from Bangladesh shows that child immunisation may have been adversely affected by the pandemic but regional evidence is limited. We therefore aimed to explore the regional differences in the indirect effects of COVID-19 on child immunisation in Bangladesh.

Methods: We extracted data from the District Health Information Software (DHIS2) spanning the period from January 2017 to December 2021. We examined three essential immunisation indicators: Bacille Calmette-Guérin (BCG), pentavalent third dose, and measles vaccinations. We examined both the yearly and monthly trends to explore fluctuations in the number of immunisations to pinpoint specific periods of service utilisation regression. Segmented regression with Poisson distribution was implemented given the count-based outcome. We reported incidence rate ratios (IRRs) with 95% confidence intervals (CIs) in different regions in 2020 and 2021 compared to the reference period (2017-19).

Results: We initially observed a notable decline in vaccine administration in April 2020 compared to the pre-pandemic period of 2017-19 with a drop of approximately 53% for BCG vaccines, 55% for pentavalent third doses, and 51% for measles vaccines followed by May 2020. The second half of 2020 saw an increase in vaccination numbers. There were noticeable regional disparities, with Sylhet (IRR = 0.75; 95% CI = 0.67-0.84 for pentavalent administration, IRR = 0.79; 95% CI = 0.71-0.88 for measles administration) and Chattogram (IRR = 0.77; 95% CI = 0.72-0.83 for BCG administration) experiencing the most significant reductions in 2020. In April 2020, Dhaka also experienced the largest decline of 67% in measles vaccination. In 2021, most divisions experienced a rebound in BCG and pentavalent administration, exceeding 2019 levels, except for Chittagong, where numbers continued to decline, falling below the 2019 figure.

Conclusions: Our findings highlight the impact of the COVID-19 pandemic on childhood immunisation across regions in Bangladesh. Sylhet, Chattogram, and Dhaka divisions experienced the most significant reductions in immunisation services during 2020. This underscores the importance of targeted interventions and regional strategies to mitigate the indirect effects of future challenges on essential health care services, particularly childhood immunisation, in Bangladesh.

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揭示地区差异:通过 COVID-19 评估孟加拉国免疫服务的中断情况。
背景:2019 年冠状病毒病(COVID-19)大流行扰乱了全世界的基本医疗保健服务,包括与免疫接种相关的服务。孟加拉国的国家数据显示,儿童免疫接种可能受到了大流行病的不利影响,但地区证据有限。因此,我们旨在探讨 COVID-19 对孟加拉国儿童免疫接种的间接影响的地区差异:我们从地区卫生信息软件(DHIS2)中提取了数据,时间跨度为 2017 年 1 月至 2021 年 12 月。我们研究了三个基本免疫指标:卡介苗(BCG)、五价三联疫苗和麻疹疫苗接种。我们研究了年度和月度趋势,以探索免疫接种次数的波动,从而确定服务利用率回归的特定时期。鉴于结果以计数为基础,我们采用了泊松分布的分段回归方法。与参照期(2017-19 年)相比,我们报告了 2020 年和 2021 年不同地区的发病率比(IRR)及 95% 置信区间(CI):与大流行前的 2017-19 年相比,我们最初观察到 2020 年 4 月的疫苗接种量明显下降,卡介苗接种量下降了约 53%,五价三联疫苗接种量下降了 55%,麻疹疫苗接种量下降了 51%,随后在 2020 年 5 月出现下降。2020 年下半年,疫苗接种数量有所增加。地区差异明显,锡尔赫特(五价疫苗接种的 IRR = 0.75;95% CI = 0.67-0.84,麻疹疫苗接种的 IRR = 0.79;95% CI = 0.71-0.88)和恰特格勒(卡介苗接种的 IRR = 0.77;95% CI = 0.72-0.83)在 2020 年的降幅最大。2020 年 4 月,达卡的麻疹疫苗接种率也下降了 67%,降幅最大。2021 年,大多数省份的卡介苗和五价疫苗接种量都有所回升,超过了 2019 年的水平,只有吉大港除外,该地区的接种量继续下降,低于 2019 年的水平:我们的研究结果突显了 COVID-19 大流行对孟加拉国各地区儿童免疫接种的影响。2020年期间,锡尔赫特、恰特洛格和达卡各区的免疫服务减少幅度最大。这凸显了有针对性的干预措施和地区战略对于减轻未来挑战对孟加拉国基本医疗保健服务(尤其是儿童免疫接种)的间接影响的重要性。
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来源期刊
Journal of Global Health
Journal of Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -
CiteScore
6.10
自引率
2.80%
发文量
240
审稿时长
6 weeks
期刊介绍: Journal of Global Health is a peer-reviewed journal published by the Edinburgh University Global Health Society, a not-for-profit organization registered in the UK. We publish editorials, news, viewpoints, original research and review articles in two issues per year.
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