Effect of COVID-19 on utilization of routine immunisation services among children below 1 year in Wakiso District, Uganda: Challenges and adaptations

Abstract

Background: COVID -19 pandemic disrupted utilization of routine immunization services in Uganda. While the stringent measures to mitigate its spread helped curb effects of the pandemic, they also likely impacted the utilization of routine immunization services (RIS) in Uganda. The study aimed to assess the effects of the COVID 19 pandemic, challenges faced and adaptations to utilization of immunization services to better inform preventive measures in a pandemic. Methods: We conducted a cross-sectional mixed method study. It involved extraction of monthly routine immunization data of children vaccinated with DPT3 from April 2019 to March 2021 from the DHIS2. Interrupted time series analysis was used to determine the effect of COVID on utilization of RIS. Qualitatively, key informants and in depth interviews were conducted to explore challenge and adaptations. Results: During the pandemic, 199,479 DPT3 doses were administered in Wakiso district. These were 35,178 (11%) lower than the expected DPT3 doses that would have been administered if the pandemic had not occurred. This represents a statistically significant mean monthly change of -1,049.1 (95% CI = -1,412.3 - 685.9). The pandemic affected the levels and trends of utilization of immunization services which led to children missing out their DPT3 doses. We noted that caretakers faced several challenges such as lack of transport means, long waiting time, and fear of contracting COVID and rescheduled immunization dates. Furthermore, adaptations to the pandemic included; increased outreaches, additional days for vaccination, VHTs supporting immunization, health education, and ensuring SOPs are followed in vaccination centres. Conclusion: The COVID-19 pandemic resulted into reduction in utilization of routine immunization services in Wakiso district. Adapting measures like involvement of VHTs to support RIS and increased outreaches may help overcome challenges and ensure continuity of use of RIS to avoid children missing their DPT3 doses.