Childhood immunization during the COVID-19 pandemic: experiences in Haiti, Lesotho, Liberia and Malawi

Connolly, Emilia; Boley, Emma Jean; Fejfar, Donald; Varney, Prince F; Aron, Moses Banda; Fulcher, Isabel R.; Lambert, Wesler; Ndayizigiye, Melino; Law, Michael R.; Mugunga, Jean-Claude; Hedt‐Gauthier, Bethany

doi:10.2471/blt.21.286774

Cited by 33 publications

(59 citation statements)

References 30 publications

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“…Some patients may be lost to follow-up after diagnosis, and surveillance systems predominantly record deaths that occur at health facilities [8], even though many deaths occur at home [9,10]. Epidemics also indirectly affect mortality, for example by disrupting health services [11][12][13]. As a result, reported counts of deaths only include a fraction of the excess mortality caused by an epidemic [14].…”

Section: Introductionmentioning

confidence: 99%

Collecting mortality data via mobile phone surveys: A non-inferiority randomized trial in Malawi

Chasukwa

Choko

Muthema³

et al. 2022

PLOS Glob Public Health

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Despite the urgent need for timely mortality data in low-income and lower-middle-income countries, mobile phone surveys rarely include questions about recent deaths. Such questions might a) be too sensitive, b) take too long to ask and/or c) generate unreliable data. We assessed the feasibility of mortality data collection using mobile phone surveys in Malawi. We conducted a non-inferiority trial among a random sample of mobile phone users. Participants were allocated to an interview about their recent economic activity or recent deaths in their family. In the group that was asked mortality-related questions, half of the respondents completed an abridged questionnaire, focused on information necessary to calculate recent mortality rates, whereas the other half completed an extended questionnaire that also included questions about symptoms and healthcare. The primary trial outcome was the cooperation rate, i.e., the number of completed interviews divided by the number of mobile subscribers invited to participate. Secondary outcomes included self-reports of negative feelings and stated intentions to participate in future interviews. We called more than 7,000 unique numbers and reached 3,054 mobile subscribers. In total, 1,683 mobile users were invited to participate. The difference in cooperation rates between those asked to complete a mortality-related interview and those asked to answer questions about economic activity was 0.9 percentage points (95% CI = -2.3, 4.1), which satisfied the non-inferiority criterion. The mortality questionnaire was non-inferior to the economic questionnaire on all secondary outcomes. Collecting mortality data required 2 to 4 additional minutes per reported death, depending on the inclusion of questions about symptoms and healthcare. More than half of recent deaths elicited during mobile phone interviews had not been registered with the National Registration Bureau. Including mortality-related questions in mobile phone surveys is feasible. It might help strengthen the surveillance of mortality in countries with deficient civil registration systems. Registration: AEA RCT Registry, #0008065 (14 September 2021).

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Section: Introductionmentioning

confidence: 99%

Collecting mortality data via mobile phone surveys: A non-inferiority randomized trial in Malawi

Chasukwa

Choko

Muthema³

et al. 2022

PLOS Glob Public Health

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“…The quality of care given to mothers has been affected, mainly in terms of incomplete and late patient examination, leading to an increased likelihood of preventable and treatable complications going untreated [ 42 ]. The pandemic has also had a negative impact on routine vaccination of children younger than 1 year [ 43 ]. A study assessing childhood immunisation during the COVID‐19 pandemic in Haiti, Lesotho, and Malawi showed an early decline in vaccination uptake in all countries except Malawi, likely due to a lack of adherence to COVID‐19 restrictions in rural areas [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…The pandemic has also had a negative impact on routine vaccination of children younger than 1 year [ 43 ]. A study assessing childhood immunisation during the COVID‐19 pandemic in Haiti, Lesotho, and Malawi showed an early decline in vaccination uptake in all countries except Malawi, likely due to a lack of adherence to COVID‐19 restrictions in rural areas [ 43 ]. Furthermore, there was a more pronounced decline in vaccination in 2021, which corresponded with peaks in COVID‐19 infections that had higher cumulative cases and case fatality rates [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…A study assessing childhood immunisation during the COVID‐19 pandemic in Haiti, Lesotho, and Malawi showed an early decline in vaccination uptake in all countries except Malawi, likely due to a lack of adherence to COVID‐19 restrictions in rural areas [ 43 ]. Furthermore, there was a more pronounced decline in vaccination in 2021, which corresponded with peaks in COVID‐19 infections that had higher cumulative cases and case fatality rates [ 43 ]. These significant declines in Malawi are likely due to increased restrictive measures and insufficient community outreach interventions during the waves; for instance, community outreach activities were suspended during the second and third waves, which caused fears of visiting health facilities [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

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Emerging public health challenges during the COVID‐19 pandemic in Malawi: A review

Chiumia

Mosiwa

Nkhonjera

et al. 2022

Public Health Challenges

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The ongoing COVID-19 pandemic has posed new and has aggravated already existing public health challenges in Malawi and worldwide. Having a better understanding of these challenges can help facilitate the identification of solutions and designing further public health interventions and policies for effective management of the COVID-19 pandemic. This article presents an overview of the situation of COVID-19 in Malawi and identifies emerging public health challenges that the country is facing amidst this pandemic. It is based on a review of relevant key policy documents, reports, and publications. Some of the key emerging challenges identified in Malawi are worsening population health and socio-economic status; health system challenges like inadequate financing and human resources, disruption of essential health services; a rise in mental health conditions and suicide rates; teenage pregnancies and early marriages; and changes in some health policies. The findings point to the need to invest more in strategies for health promotion, health system strengthening and avoiding disruptions and recovery of services. These should include COVID-19 vaccination promotion campaigns, improvement of the public health surveillance system, strengthening the health workforce, implementation of health financing strategies, procurement of adequate essential medicines and supplies, and strengthening of youth-friendly reproductive health services, community health services and community engagement. These will ensure that the health system in Malawi is well-equipped to deliver resilient, sustainable and quality health services amidst and beyond the COVID-19 pandemic thereby promoting progress toward the achievement of Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) in Malawi.

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“…Although the major focus has been accessing COVID-19 vaccination, 1 ever-mounting evidence exists to suggest that childhood vaccination programmes generally have been disrupted, for a number of reasons, including restrictions of population movement due to national lockdowns early in the COVID-19 pandemic, and later predominantly due to vaccine stockouts. 2 , 3 Novel strategies to circumvent vaccine stockouts might decrease the impact of disrupted vaccination programmes, including using different formulations of homologous vaccines or the use of heterologous vaccine strategies for mixed vaccine schedules. Questions will always be asked however whether these alternative solutions are as effective as vaccination programmes with a single formulation vaccine, the standard method for evaluating vaccine efficacy.…”

mentioning

confidence: 99%

Vaccine pragmatism in the 21st century

Keddy¹

2022

The Lancet Infectious Diseases

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Childhood immunization during the COVID-19 pandemic: experiences in Haiti, Lesotho, Liberia and Malawi

Cited by 33 publications

References 30 publications

Collecting mortality data via mobile phone surveys: A non-inferiority randomized trial in Malawi

Collecting mortality data via mobile phone surveys: A non-inferiority randomized trial in Malawi

Emerging public health challenges during the COVID‐19 pandemic in Malawi: A review

Vaccine pragmatism in the 21st century

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