JMIR Publications

ABSTRACT

Background:

The Covid-19 pandemic is declared as the worst public health crises in the world, with over 50 million global confirmed cases and 1,256,869 global deaths across 214 countries and territories as of November 09, 2020. Among 73 GAVI eligible countries, 69 of them have reported Covid-19 cases, Indonesia, India and Pakistan are those countries which comprising the highest number of cases. Afghanistan reported the first case of Covid-19 in 24th Feb 2020 in Herat province which was imported case and had travel history from Iran. Afghanistan reported 42,092 confirmed cases and 1,558 deaths as of November 09, 2020. During Covid-19 around 300,000 Afghans returned from Iran and Pakistan and this overwhelmed government’s attempts to control the outbreak. There is no specific treatment for Covid-19 and no vaccine has been introduced yet. However, WHO recommends some measures in order to decrease the spread of virus transmission such as physical distance, avoid gathering, closure of school and Universities, wearing masks and home quarantine. Despite the lock down of cities, the health service delivery remains open in Afghanistan during Covid-19 pandemic. The reporting of confirmed cases remains low, only the health facilities were reporting the confirmed cases and deaths. Hospitals began loses of staffs, health staff not only becoming ill or dying but they were not present to work under conditions with high contaminate environment and health hazardous. The reporting data of Covid-19 was unreliable, at first government only managed 100 tests per day and majority of people didn’t have access to HFs for testing which caused that virus started community transmission. As per recent nationwide population based sero epidemiological study that ministry of public health conducted in July in nine regions of Afghanistan, around 10 million people affected by Covid-19. Total proportion of Covid-19 positive infection rate was 31.5%. The highest proportion of Covid-19 positive infection was in Kabul region (53%). East region had the 2nd highest proportion of Covid-19 positive infections rate which was 43% (MoPH, 2020). Routine immunization is a vital component in reducing morbidity and mortality and one of the top priority for the ministry of public health. The health facilities which provide EPI services remained open all over the country but the outreach and mobile sessions were mostly suspended due to lockdown and families were unable to reach HFs due to restrictions. In Kenya, the EPI performance was dropped 20% in the 2nd quarter of 2020. In addition, In Bangaldesh the Penta-3 coverage was 50% lower in April 2020 compared to the same period in 2019. As we reviewed the routine immunization coverage for Pakistan, the first case of Covid-19 in Pakistan was reported in 26th February 2020 and reported 344,839 confirmed cases and 6,977 deaths as of November 09, 2020. More than one million children had missed vaccine doses by 1 July 2020 in Pakistan. The immunization coverage decreased 49% for Penta-3 during Mar-Apr,2020 as compared with 2019 for the same months in Pakistan. Generally, the immunization uptake dropped by more than half during Covid-19 in Pakistan (GAVI, 2020).

Objective:

The primary objective of the study is to analysis the data that how much the EPI performance dropped during Covid-19 and see its impact on routine immunization coverage. The secondary objectives of the study are: • To analyze the data of April, May, June and July months for 2019 and 2020 and compare the coverages of different antigens in this period. • To know how much the coverage of routine immunization dropped due to Covid-19 pandemic. • Trend analyze of Penta-3, Measles-1 and TT2+(PW) coverage from December 2019 to August 2020.

Methods:

It is a descriptive analysis of secondary data that existed in the EPIMIS database at national level. EPIMIS database is a part of the HMIS at Ministry of Public Health, which was developed in 2015 and it is used as a data collection and extraction tool at national and provincial level. We extracted routine immunization data from EPIMIS database from April-July of both 2019 and 2020 years for comparison. In addition, we reviewed the trend analysis from December 2019, to August 2020 comparing four months prior to lockdown (from Dec-19 to Mar 2020) with Covid-19 lockdown period (from Apr to July 2020). We managed and analyzed the data using Ms. Excel 2016 and Epi info7.2.

Results:

Data for EPI main indicators analyzed at national and provincial level. As shown in graph the, routine immunization coverage dropped 11%, 2% and 12% for Penta-3, Measles-1 and TT2+(PW) respectively during Covid-19 Pandemic lockdown period (April to July, 2020) as compared to 2019 for the same period. During lockdown the Supplementary Immunization Activities (SIAs) for polio eradication at nationwide which were scheduled on May and June were postponed as well. However, the coverage for OPV-3 decreased 6% during lockdown as compared with same period of last year. The table shows the dropped percentage of all antigen from April to July of 2020 compared to the same period of 2019. The high dropped coverage was observed for TT2+(PW) and Penta-3 respectively. Moreover, Coverage at provincial level also decreased due to Covid-19 pandemic. The highest decreased coverage for Penta-3 and Measles-1 was observed 45% and 43% in Paktya province during Covid-19 pandemic as compared to the same period of 2019. In addition, the highest TT2+ coverage for pregnant women dropped in Kunduz province which is 67%. During lockdown almost 200 HFs were closed and the provision of fixed, outreach and mobile sessions were limited due to Covid-19. The fixed sessions declined 3% while outreach sessions declined 1% during lockdown period. Overall, 202,408 children in fixed and 24,173 children in mobile sessions were missed in lockdown period due to Covid-19 as compared to the same period of 2019. The decline was observed on Penta-3, Measles-1 and TT2+ (PW) coverage due to Covid-19. The trend analyzes for Penta-3, Measles-1 and TT2+(PW) from December 2019 to August 2020 indicates that the coverage of routine immunization slightly declined from April to July, 2020 as compared to the prior lockdown period. Based on the trend analyzes, Immunization coverage start to be resumed from July 2020.

Conclusions:

As compared to the regional countries in which the EPI performance dropped with high percentage, routine immunization coverage in Afghanistan dropped 11% for Penta-3 and 2% for Measles-1 during lockdown period due to Covid-19. This reveals that Afghanistan EPI team performed better during crisis than lower middle-income countries. However, there is a need to properly plan to protect essential health services during emergencies. In addition, performance of fixed and outreach sessions for EPI activities were declined 3% and 1% respectively during lockdown which had minor impact on routine immunization activities.