Delays in Childhood Immunization in a Conflict Area: a Study from Sierra Leone During Civil War

Overview

Journal Confl Health

Publisher Biomed Central

Specialty Public Health

Date 2007 Dec 11

PMID 18067680

Citations 13

Authors

Charles Senessie

George N Gage

Erik von Elm

Affiliations

Soon will be listed here.

Abstract

Background: Sierra Leone has undergone a decade of civil war from 1991 to 2001. From this period few data on immunization coverage are available, and conflict-related delays in immunization according to the Expanded Programme on Immunization (EPI) schedule have not been investigated. We aimed to study delays in childhood immunization in the context of civil war in a Sierra Leonean community.

Methods: We conducted an immunization survey in Kissy Mess-Mess in the Greater Freetown area in 1998/99 using a two-stage sampling method. Based on immunization cards and verbal history we collected data on immunization for tuberculosis, diphtheria, tetanus, pertussis, polio, and measles by age group (0-8/9-11/12-23/24-35 months). We studied differences between age groups and explored temporal associations with war-related hostilities taking place in the community.

Results: We included 286 children who received 1690 vaccine doses; card retention was 87%. In 243 children (85%, 95% confidence interval (CI): 80-89%) immunization was up-to-date. In 161 of these children (56%, 95%CI: 50-62%) full age-appropriate immunization was achieved; in 82 (29%, 95%CI: 24-34%) immunization was not appropriate for age. In the remaining 43 children immunization was partial in 37 (13%, 95%CI: 9-17) and absent in 6 (2%, 95%CI: 1-5). Immunization status varied across age groups. In children aged 9-11 months the proportion with age-inappropriate (delayed) immunization was higher than in other age groups suggesting an association with war-related hostilities in the community.

Conclusion: Only about half of children under three years received full age-appropriate immunization. In children born during a period of increased hostilities, immunization was mostly inappropriate for age, but recommended immunizations were not completely abandoned. Missing or delayed immunization represents an additional threat to the health of children living in conflict areas.

Citing Articles

Trends and inequalities in BCG immunisation coverage among one-year-olds in Sierra Leone, 2008-2019.

Osborne A, Wongnaah F, Bangura C, Ahinkorah B BMC Public Health. 2024; 24(1):3342.

PMID: 39616317 PMC: 11607882. DOI: 10.1186/s12889-024-20560-3.

Immunisation coverage and factors associated with incomplete immunisation in children under two during the COVID-19 pandemic in Sierra Leone.

Wassenaar M, Fombah A, Chen H, Owusu-Kyei K, Williams J, Sunders J BMC Public Health. 2024; 24(1):143.

PMID: 38200476 PMC: 10777622. DOI: 10.1186/s12889-023-17534-2.

Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps.

Wariri O, Okomo U, Kwarshak Y, Utazi C, Murray K, Grundy C PLOS Glob Public Health. 2023; 2(7):e0000325.

PMID: 36962319 PMC: 10021799. DOI: 10.1371/journal.pgph.0000325.

Changes in childhood vaccination coverage over time in the Democratic Republic of the Congo.

Alfonso V, Bratcher A, Ashbaugh H, Doshi R, Gadoth A, Hoff N PLoS One. 2019; 14(5):e0217426.

PMID: 31125375 PMC: 6534301. DOI: 10.1371/journal.pone.0217426.

Vaccination timeliness and delay in low- and middle-income countries: a systematic review of the literature, 2007-2017.

Masters N, Wagner A, Boulton M Hum Vaccin Immunother. 2019; 15(12):2790-2805.

PMID: 31070992 PMC: 6930087. DOI: 10.1080/21645515.2019.1616503.

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