The COVID-19 pandemic has affected child immunisation service delivery and use across the globe.1, 2, 3, 4 Amid overwhelming reports of disrupted immunisation services during the early pandemic months, the Correspondence by Anna A Jarchow-MacDonald and colleagues5 drew our interest. The authors reported on stable child immunisation services in the Lothian area of Scotland during the lockdown period and described attributable adaptations and strategies.
After the first COVID-19 case was diagnosed in March, 2020, child health service delivery and use declined in rural remote communities in Bangladesh. We retrieved annual data for 2019 and 2020 from Bangladesh's district health information system (DHIS) for child immunisation and sick children's care-seeking in six subdistricts of Barishal, Bangladesh.
34 838 children younger than 5 years sought care in 2020, which was 11% fewer than the previous year (39 078). The greatest decline in care-seeking for sick children younger than 5 years was observed during April–July (70%; 4151 in 2020 vs 13 983 in 2019). After July, 2020, care-seeking for sick children began to increase (appendix) and 23% more children younger than 5 years sought care during August to December in 2020 than in the same period in 2019 (20 159 vs 16 348).
Child immunisation services were mostly disrupted in April and May, 2020, when 20% (280 of 1414) and 25% (346 of 1395) of planned outreach immunisation sessions were cancelled, respectively (appendix). On average, the greatest disruption was observed during these months in three remote subdistricts: Hijla (57% [185 of 322]), Agailjhara (25% [69 of 275]), and Mehendiganj (20% [135 of 660]). Available data and reports from DHIS revealed the halt of further disruption and improved child immunisation coverage during post-disruption months (July–October, 2020; appendix). On average, about 99% of immunisation sessions were held during July–October, 2020 (appendix).
We adopted alternate approaches, similar to some of those reported by Jarchow-MacDonald and colleagues,5to stop further disruption and to improve child health and immunisation service coverage within our project catchment area. We facilitated the district health management and local ministry of health authority to train service providers and use resources from other programmes to ensure infection prevention and control initiatives. We also facilitated district and local health management teams to organise mobile immunisation outreach services and crash immunisation campaigns in hard-to-reach remote areas, tracing and immunising children who had missed their vaccinations, and targeted home visits by community health workers.
Our experience suggests that need-based and context-specific alternate approaches might help to catch-up and improve child health and immunisation services that have been affected by the pandemic in remote rural communities of countries like Bangladesh.
We declare no competing interests.
Supplementary Material
References
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