Peer-reviewed article
Reasons for reductions in routine childhood immunisation uptake during the COVID-19 pandemic in low- and middle-income countries: A systematic review
Alexandra Cardoso Pinto, Sameed Shariq, Lasith Ranasinghe, Shyam Sundar Budhathoki, Helen Skirrow et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined why routine childhood immunisations declined in low- and middle-income countries during the COVID-19 pandemic. The study analysed 13 studies (7 quantitative, 5 qualitative, 1 mixed methods) and identified 17 reasons for disruptions. The most common reasons were parental fear of COVID-19 and avoidance of health centres (41.2%), followed by transport challenges (11.1%). Most disruptions came from reduced healthcare-seeking behaviour rather than healthcare delivery failures.
Key points
- Fear of COVID-19 and consequential avoidance of health centres was the most common reason for missed immunisations (41.2% in quantitative studies)
- Transport challenges preventing families and healthcare workers from reaching vaccination services accounted for 11.1% of disruptions
- 83.4% of reasons for disruption stemmed from reduced healthcare-seeking, while 15.2% were healthcare-delivery issues
- Qualitative studies showed more balanced healthcare-seeking (49.5%) versus healthcare-delivery issues (50.5%)
- The review included 2,853 respondents across quantitative studies and 92 respondents across qualitative studies
Limitations
The review includes studies published only until February 2022, so does not capture later pandemic developments. The geographical representation and quality of included studies are not detailed, limiting understanding of whether findings apply consistently across all low- and middle-income countries.
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in a substantial decline in routine immunisation coverage in children globally, especially in low- and middle-income countries (LMICs). This study summarises the reasons for disruptions to routine child immunisations in LMICs. A systematic review (PROSPERO CRD42021286386) was conducted following PRISMA 2020 guidelines. Six databases were searched: MEDLINE, Embase, Global Health, CINAHL, Scopus and MedRxiv, on 11/02/2022. Observational and qualitative studies published from January 2020 onwards were included if exploring reasons for missed immunisations during the COVID-19 pandemic in LMICs. Study appraisal used National Heart, Lung, and Blood Institute and Critical Appraisal Skills Programme tools. Reasons for disruption were defined with descriptive codes; cross-sectional (quantitative) data were summarised as mean percentages of responses weighted by study population, and qualitative data were summarised narratively. A total of thirteen studies were included describing reasons behind disruptions; 7 cross-sectional (quantitative), 5 qualitative and 1 mixed methods. Seventeen reasons for disruptions were identified. In quantitative studies (total respondents = 2,853), the most common reasons identified were fear of COVID-19 and consequential avoidance of health centres (41.2%, SD ±13.3%), followed by transport challenges preventing both families and healthcare professionals from reaching vaccination services (11.1% SD ±16.6%). Most reasons stemmed from reduced healthcare-seeking (83.4%), as opposed to healthcare-delivery issues (15.2%). Qualitative studies showed a more even balance of healthcare-seeking (49.5%) and healthcare-delivery issues (50.5%), with fear of COVID-19 remaining a major identified issue (total respondents = 92). The most common reasons for disruption were parental fear of COVID-19 and avoidance of health services. Health systems must therefore prioritise public health messaging to encourage vaccine uptake and recovery of missed immunisations.