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  1. Article ; Online: Timeliness of routine childhood vaccination among 12-35 months old children in The Gambia: Analysis of national immunisation survey data, 2019-2020.

    Wariri, Oghenebrume / Utazi, Chigozie Edson / Okomo, Uduak / Sogur, Malick / Murray, Kris A / Grundy, Chris / Fofanna, Sidat / Kampmann, Beate

    PloS one

    2023  Volume 18, Issue 7, Page(s) e0288741

    Abstract: The Gambia's routine childhood vaccination programme is highly successful, however, many vaccinations are delayed, with potential implications for disease outbreaks. We adopted a multi-dimensional approach to determine the timeliness of vaccination (i.e., ...

    Abstract The Gambia's routine childhood vaccination programme is highly successful, however, many vaccinations are delayed, with potential implications for disease outbreaks. We adopted a multi-dimensional approach to determine the timeliness of vaccination (i.e., timely, early, delayed, and untimely interval vaccination). We utilised data for 3,248 children from The Gambia 2019-2020 Demographic and Health Survey. Nine tracer vaccines administered at birth and at two, three, four, and nine months of life were included. Timeliness was defined according to the recommended national vaccination windows and reported as both categorical and continuous variables. Routine coverage was high (above 90%), but also a high rate of untimely vaccination. First-dose pentavalent vaccine (PENTA1) and oral polio vaccine (OPV1) had the highest timely coverage that ranged from 71.8% (95% CI = 68.7-74.8%) to 74.4% (95% CI = 71.7-77.1%). Delayed vaccination was the commonest dimension of untimely vaccination and ranged from 17.5% (95% CI = 14.5-20.4%) to 91.1% (95% CI = 88.9-93.4%), with median delays ranging from 11 days (IQR = 5, 19.5 days) to 28 days (IQR = 11, 57 days) across all vaccines. The birth-dose of Hepatitis B vaccine had the highest delay and this was more common in the 24-35 months age group (91.1% [95% CI = 88.9-93.4%], median delays = 17 days [IQR = 10, 28 days]) compared to the 12-23 months age-group (84.9% [95% CI = 81.9-87.9%], median delays = 16 days [IQR = 9, 26 days]). Early vaccination was the least common and ranged from 4.9% (95% CI = 3.2-6.7%) to 10.7% (95% CI = 8.3-13.1%) for all vaccines. The Gambia's childhood immunization system requires urgent implementation of effective strategies to reduce untimely vaccination in order to optimize its quality, even though it already has impressive coverage rates.
    MeSH term(s) Infant, Newborn ; Humans ; Child ; Infant ; Child, Preschool ; Gambia/epidemiology ; Immunization Schedule ; Vaccination ; Immunization ; Immunization Programs ; Hepatitis B Vaccines
    Chemical Substances Hepatitis B Vaccines
    Language English
    Publishing date 2023-07-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0288741
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Mapping the timeliness of routine childhood vaccination in The Gambia: A spatial modelling study.

    Wariri, Oghenebrume / Utazi, Chigozie Edson / Okomo, Uduak / Metcalf, C Jessica E / Sogur, Malick / Fofana, Sidat / Murray, Kris A / Grundy, Chris / Kampmann, Beate

    Vaccine

    2023  Volume 41, Issue 39, Page(s) 5696–5705

    Abstract: Introduction: Timeliness of routine vaccination shapes childhood infection risk and thus is an important public health metric. Estimates of indicators of the timeliness of vaccination are usually produced at the national or regional level, which may ... ...

    Abstract Introduction: Timeliness of routine vaccination shapes childhood infection risk and thus is an important public health metric. Estimates of indicators of the timeliness of vaccination are usually produced at the national or regional level, which may conceal epidemiologically relevant local heterogeneities and makeitdifficultto identify pockets of vulnerabilities that could benefit from targeted interventions. Here, we demonstrate the utility of geospatial modelling techniques in generating high-resolution maps of the prevalence of delayed childhood vaccination in The Gambia. To guide local immunisation policy and prioritize key interventions, we also identified the districts with a combination of high estimated prevalence and a significant population of affected infants.
    Methods: We used the birth dose of the hepatitis-B vaccine (HepB0), third-dose of the pentavalent vaccine (PENTA3), and the first dose of measles-containing vaccine (MCV1) as examples to map delayed vaccination nationally at a resolution of 1 × 1-km
    Results: We found significant subnational heterogeneity in delayed HepB0, PENTA3 and MCV1 vaccinations. Specificdistricts in the central and eastern regions of The Gambia consistentlyexhibited the highest prevalence of delayed vaccination, while the coastal districts showed alower prevalence forallthree vaccines. We also found that districts in the eastern, central, as well as in coastal parts of The Gambia had a combination of high estimated prevalence of delayed HepB0, PENTA3 and MCV1 and a significant population of affected infants.
    Conclusions: Our approach provides decision-makers with a valuable tool to better understand local patterns of untimely childhood vaccination and identify districts where strengthening vaccine delivery systems could have the greatest impact.
    MeSH term(s) Infant ; Humans ; Gambia/epidemiology ; Bayes Theorem ; Measles Vaccine ; Vaccination ; Hepatitis B Vaccines ; Immunization Programs
    Chemical Substances Measles Vaccine ; Hepatitis B Vaccines
    Language English
    Publishing date 2023-08-08
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2023.08.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Mapping the timeliness of routine childhood vaccination in The Gambia: A spatial modelling study

    Wariri, Oghenebrume / Utazi, Chigozie Edson / Okomo, Uduak / Metcalf, C. Jessica E. / Sogur, Malick / Fofana, Sidat / Murray, Kris A. / Grundy, Chris / Kampmann, Beate

    Vaccine. 2023 Aug. 08,

    2023  

    Abstract: Timeliness of routine vaccination shapes childhood infection risk and thus is an important public health metric. Estimates of indicators of the timeliness of vaccination are usually produced at the national or regional level, which may conceal ... ...

    Abstract Timeliness of routine vaccination shapes childhood infection risk and thus is an important public health metric. Estimates of indicators of the timeliness of vaccination are usually produced at the national or regional level, which may conceal epidemiologically relevant local heterogeneities and makeitdifficultto identify pockets of vulnerabilities that could benefit from targeted interventions. Here, we demonstrate the utility of geospatial modelling techniques in generating high-resolution maps of the prevalence of delayed childhood vaccination in The Gambia. To guide local immunisation policy and prioritize key interventions, we also identified the districts with a combination of high estimated prevalence and a significant population of affected infants. We used the birth dose of the hepatitis-B vaccine (HepB0), third-dose of the pentavalent vaccine (PENTA3), and the first dose of measles-containing vaccine (MCV1) as examples to map delayed vaccination nationally at a resolution of 1 × 1-km² pixel. We utilized cluster-level childhood vaccination data from The Gambia 2019–20 Demographic and Health Survey. We adopted a fully Bayesian geostatistical model incorporating publicly available geospatial covariates to aid predictive accuracy. The model was implemented using the integrated nested Laplace approximation—stochastic partial differential equation (INLA-SPDE) approach. We found significant subnational heterogeneity in delayed HepB0, PENTA3 and MCV1 vaccinations. Specificdistricts in the central and eastern regions of The Gambia consistentlyexhibited the highest prevalence of delayed vaccination, while the coastal districts showed alower prevalence forallthree vaccines. We also found that districts in the eastern, central, as well as in coastal parts of The Gambia had a combination of high estimated prevalence of delayed HepB0, PENTA3 and MCV1 and a significant population of affected infants. Our approach provides decision-makers with a valuable tool to better understand local patterns of untimely childhood vaccination and identify districts where strengthening vaccine delivery systems could have the greatest impact.
    Keywords Bayesian theory ; childhood ; decision making ; differential equation ; geostatistics ; health surveys ; issues and policy ; models ; public health ; risk ; vaccination ; vaccines ; Gambia
    Language English
    Dates of publication 2023-0808
    Publishing place Elsevier Ltd
    Document type Article ; Online
    Note Pre-press version
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2023.08.004
    Database NAL-Catalogue (AGRICOLA)

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  4. Article: Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015-2021.

    Wariri, Oghenebrume / Utazi, Chigozie Edson / Okomo, Uduak / Sowe, Alieu / Sogur, Malick / Fofanna, Sidat / Ezeani, Esu / Saidy, Lamin / Sarwar, Golam / Dondeh, Bai-Lamin / Murray, Kris A / Grundy, Chris / Kampmann, Beate

    BMJ global health

    2023  Volume 8, Issue 12

    Abstract: Introduction: The COVID-19 pandemic caused widespread morbidity and mortality and resulted in the biggest setback in routine vaccinations in three decades. Data on the impact of the pandemic on immunisation in Africa are limited, in part, due to low- ... ...

    Abstract Introduction: The COVID-19 pandemic caused widespread morbidity and mortality and resulted in the biggest setback in routine vaccinations in three decades. Data on the impact of the pandemic on immunisation in Africa are limited, in part, due to low-quality routine or administrative data. This study examined coverage and timeliness of routine childhood immunisation during the pandemic in The Gambia, a country with an immunisation system considered robust.
    Methods: We obtained prospective birth cohort data of 57 286 children in over 300 communities in two health and demographic surveillance system sites, including data from the pre-pandemic period (January 2015-February 2020) and the three waves of the pandemic period (March 2020-December 2021). We determined monthly coverage and timeliness (early and delayed) of the birth dose of hepatitis B vaccine (HepB0) and the first dose of pentavalent vaccine (Penta1) during the different waves of the pandemic relative to the pre-pandemic period. We implemented a binomial interrupted time-series regression model.
    Result: We observed no significant change in the coverage of HepB0 and Penta1 vaccinations from the pre-pandemic period up until the periods before the peaks of the first and second waves of the pandemic in 2020. However, there was an increase in HepB0 coverage before as well as after the peak of the third wave in 2021 compared with the pre-pandemic period (pre-third wave peak OR = 1.83, 95% CI 1.06 to 3.14; post-third wave period OR=2.20, 95% CI 1.23 to 3.92). There was some evidence that vaccination timeliness changed during specific periods of the pandemic. Early Penta1 vaccination decreased by 70% (OR=0.30, 95% CI 0.12 to 0.78) in the period before the second wave, and delayed HepB0 vaccination decreased by 47% (OR=0.53, 95% CI 0.29 to 0.97) after the peak of the third wave in 2021.
    Conclusion: Despite the challenges of the COVID-19 pandemic, The Gambia's routine vaccination programme has defied the setbacks witnessed in other settings and remained resilient, with coverage increasing and timeliness improving during the second and third waves. These findings highlight the importance of having adequate surveillance systems to monitor the impact of large shocks to vaccination coverage and timeliness.
    MeSH term(s) Child ; Humans ; Pandemics/prevention & control ; Gambia/epidemiology ; Prospective Studies ; COVID-19/epidemiology ; COVID-19/prevention & control ; Immunization Schedule ; Immunization ; Vaccination
    Language English
    Publishing date 2023-12-26
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2059-7908
    ISSN 2059-7908
    DOI 10.1136/bmjgh-2023-014225
    Database MEDical Literature Analysis and Retrieval System OnLINE

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