Analyzing Subnational Immunization Coverage to Catch up and Reach the Unreached in Seven High-Priority Countries in the Eastern Mediterranean Region, 2019–2021
Yearly national immunization coverage reporting does not measure performance at the subnational level throughout the year and conceals inequalities within countries. We analyzed subnational immunization coverage from seven high-priority countries in our region. We analyzed subnational, monthly immun...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-03-01
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| Series: | Vaccines |
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| Online Access: | https://www.mdpi.com/2076-393X/12/3/285 |
| _version_ | 1797239099843674112 |
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| author | Kamal Fahmy Quamrul Hasan Md Sharifuzzaman Yvan Hutin |
| author_facet | Kamal Fahmy Quamrul Hasan Md Sharifuzzaman Yvan Hutin |
| author_sort | Kamal Fahmy |
| collection | DOAJ |
| description | Yearly national immunization coverage reporting does not measure performance at the subnational level throughout the year and conceals inequalities within countries. We analyzed subnational immunization coverage from seven high-priority countries in our region. We analyzed subnational, monthly immunization data from seven high-priority countries. Five were Gavi eligible (i.e., Afghanistan, Pakistan, Somalia, Syria, and Yemen); these are countries that according to their low income are eligible for support from the Global Alliance on Vaccine and Immunization, while Iraq and Jordan were included because of a recent decrease in immunization coverage and contribution to the regional number of under and unimmunized children. DTP3 coverage, which is considered as the main indicator for the routine immunization coverage as the essential component of the immunization program performance, varied monthly in 2019–2021 before reaching pre-pandemic coverage in the last two months of 2021. Somalia and Yemen had a net gain in DTP3 coverage at the end of 2021, as improvement in 2021 exceeded the regression in 2020. In Pakistan and Iraq, DTP3 improvement in 2021 equaled the 2020 regression. In Afghanistan, Syria and Jordan, the regression in DTP3 coverage continued in 2020 and 2021. The number of districts with at least 6000 zero-dose children improved moderately in Afghanistan and substantially in Somalia throughout the follow-up period. In Pakistan, the geographical distribution differed between 2020 and 2021.Of the three countries with the highest number of zero-dose children, DTP1 coverage reached 109% in Q4 of 2020 after a sharp drop to 69% in Q2 of 2020. However, in Pakistan, the number of zero-dose children decreased to 1/10 of its burden in Q4 of 2021. In Afghanistan, the number of zero-dose children more than a doubled. Among the even countries, adaptation of immunization service to the pandemic varied, depending on the agility of the health system and the performance of the components of the expanded program on immunization. We recommended monitoring administrative monthly immunization coverage data at the subnational level to detect low-performing districts, plan catchup, identify bottlenecks towards reaching unvaccinated children and customize strategies to improve the coverage in districts with zero-dose children throughout the year and monitor progress. |
| first_indexed | 2024-04-24T17:46:09Z |
| format | Article |
| id | doaj.art-726c828649db47ac87817fff16f9dc7b |
| institution | Directory Open Access Journal |
| issn | 2076-393X |
| language | English |
| last_indexed | 2024-04-24T17:46:09Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Vaccines |
| spelling | doaj.art-726c828649db47ac87817fff16f9dc7b2024-03-27T14:07:02ZengMDPI AGVaccines2076-393X2024-03-0112328510.3390/vaccines12030285Analyzing Subnational Immunization Coverage to Catch up and Reach the Unreached in Seven High-Priority Countries in the Eastern Mediterranean Region, 2019–2021Kamal Fahmy0Quamrul Hasan1Md Sharifuzzaman2Yvan Hutin3Universal Health Coverage (UHC)/Department of Communicable Disease Prevention and Control (DCD), Immunization, Vaccine Preventable Diseases and Polio Transition (IVP), World Health Organization Regional Office for the Eastern Mediterranean, Cairo 34222, EgyptUniversal Health Coverage (UHC)/Department of Communicable Disease Prevention and Control (DCD), Immunization, Vaccine Preventable Diseases and Polio Transition (IVP), World Health Organization Regional Office for the Eastern Mediterranean, Cairo 34222, EgyptUniversal Health Coverage (UHC)/Department of Communicable Disease Prevention and Control (DCD), Immunization, Vaccine Preventable Diseases and Polio Transition (IVP), World Health Organization Regional Office for the Eastern Mediterranean, Cairo 34222, EgyptUniversal Health Coverage (UHC)/Department of Communicable Disease Prevention and Control (DCD), World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, EgyptYearly national immunization coverage reporting does not measure performance at the subnational level throughout the year and conceals inequalities within countries. We analyzed subnational immunization coverage from seven high-priority countries in our region. We analyzed subnational, monthly immunization data from seven high-priority countries. Five were Gavi eligible (i.e., Afghanistan, Pakistan, Somalia, Syria, and Yemen); these are countries that according to their low income are eligible for support from the Global Alliance on Vaccine and Immunization, while Iraq and Jordan were included because of a recent decrease in immunization coverage and contribution to the regional number of under and unimmunized children. DTP3 coverage, which is considered as the main indicator for the routine immunization coverage as the essential component of the immunization program performance, varied monthly in 2019–2021 before reaching pre-pandemic coverage in the last two months of 2021. Somalia and Yemen had a net gain in DTP3 coverage at the end of 2021, as improvement in 2021 exceeded the regression in 2020. In Pakistan and Iraq, DTP3 improvement in 2021 equaled the 2020 regression. In Afghanistan, Syria and Jordan, the regression in DTP3 coverage continued in 2020 and 2021. The number of districts with at least 6000 zero-dose children improved moderately in Afghanistan and substantially in Somalia throughout the follow-up period. In Pakistan, the geographical distribution differed between 2020 and 2021.Of the three countries with the highest number of zero-dose children, DTP1 coverage reached 109% in Q4 of 2020 after a sharp drop to 69% in Q2 of 2020. However, in Pakistan, the number of zero-dose children decreased to 1/10 of its burden in Q4 of 2021. In Afghanistan, the number of zero-dose children more than a doubled. Among the even countries, adaptation of immunization service to the pandemic varied, depending on the agility of the health system and the performance of the components of the expanded program on immunization. We recommended monitoring administrative monthly immunization coverage data at the subnational level to detect low-performing districts, plan catchup, identify bottlenecks towards reaching unvaccinated children and customize strategies to improve the coverage in districts with zero-dose children throughout the year and monitor progress.https://www.mdpi.com/2076-393X/12/3/285subnational immunization coverageunder-immunized childrenimmunization inequalityzero-dose childrenCOVID pandemic |
| spellingShingle | Kamal Fahmy Quamrul Hasan Md Sharifuzzaman Yvan Hutin Analyzing Subnational Immunization Coverage to Catch up and Reach the Unreached in Seven High-Priority Countries in the Eastern Mediterranean Region, 2019–2021 Vaccines subnational immunization coverage under-immunized children immunization inequality zero-dose children COVID pandemic |
| title | Analyzing Subnational Immunization Coverage to Catch up and Reach the Unreached in Seven High-Priority Countries in the Eastern Mediterranean Region, 2019–2021 |
| title_full | Analyzing Subnational Immunization Coverage to Catch up and Reach the Unreached in Seven High-Priority Countries in the Eastern Mediterranean Region, 2019–2021 |
| title_fullStr | Analyzing Subnational Immunization Coverage to Catch up and Reach the Unreached in Seven High-Priority Countries in the Eastern Mediterranean Region, 2019–2021 |
| title_full_unstemmed | Analyzing Subnational Immunization Coverage to Catch up and Reach the Unreached in Seven High-Priority Countries in the Eastern Mediterranean Region, 2019–2021 |
| title_short | Analyzing Subnational Immunization Coverage to Catch up and Reach the Unreached in Seven High-Priority Countries in the Eastern Mediterranean Region, 2019–2021 |
| title_sort | analyzing subnational immunization coverage to catch up and reach the unreached in seven high priority countries in the eastern mediterranean region 2019 2021 |
| topic | subnational immunization coverage under-immunized children immunization inequality zero-dose children COVID pandemic |
| url | https://www.mdpi.com/2076-393X/12/3/285 |
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