The effect of COVID-19 pandemic on routine childhood vaccination coverage and experiences of parents and healthcare workers in the Western Urban Area of Sierra Leone

Résumé fourni par la source

The COVID-19 pandemic period was associated with immediate declines in coverage for several health interventions, including routine childhood immunisation programmes. In Sierra Leone, public health response measures, service delivery interruptions, and changes in healthcare-seeking behaviour may have affected vaccination coverage. This study assessed the temporal association between the COVID-19 pandemic period and routine immunisation coverage and explored contextual factors influencing service utilisation. A convergent mixed-methods study was conducted using monthly routine immunisation data from health facilities across pre-pandemic (March 2018-February 2020) and pandemic (March 2020-February 2022) periods. Segmented regression within an interrupted time-series (ITS) framework was used to estimate immediate level changes and post-interruption trend changes in vaccination coverage following the onset of the pandemic period (March 2020). Qualitative data were collected through in-depth interviews with caregivers and healthcare workers to contextualise quantitative findings. Vaccination coverage declined across all antigens following the onset of the COVID-19 pandemic. Segmented regression analysis showed significant immediate reductions in coverage for Pentavalent 1 (β = −0.649, p = 0.025), Pentavalent 2 (β = −0.889, p < 0.001), Pentavalent 3 (β = −1.047, p < 0.001), Measles-Rubella 1 (β = −0.183, p < 0.001), and Measles-Rubella 2 (β = −0.906, p < 0.001). Significant positive post-pandemic trends were observed for BCG, Pentavalent 1–3, and Measles-Rubella 1, indicating gradual recovery in vaccination coverage over time, while no significant recovery was observed for Measles-Rubella 2. Qualitative findings identified fear of COVID-19 infection, transport and financial constraints, and service disruptions as key barriers to vaccination uptake. Recovery was facilitated by community outreach, health education, infection-prevention measures, and defaulter tracing activities. The COVID-19 pandemic was associated with substantial disruption of routine childhood immunisation services in the Western Urban Area of Sierra Leone. Although vaccination coverage gradually recovered following targeted mitigation measures, recovery remained incomplete for some antigens. Strengthening health-system resilience, maintaining essential immunisation services during public-health emergencies, and expanding community-based outreach are critical for sustaining vaccination coverage during future outbreaks.

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