ArticleVaccine2020
Impact of COVID-19 pandemic response on uptake of routine immunizations in Sindh, Pakistan: An analysis of provincial electronic immunization registry data.
Article in Vaccine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 135 papers, 7 of them syntheses that pooled it.
What it found
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Who cites it
135 citing papers in PubMed, 7 syntheses or guidelines pooled it, 241 citations in OpenAlex.
- Measles Vaccine Coverage and Disease Outbreaks: A Systematic Review of the Early Impact of COVID-19 in Low and Lower-Middle Income Countries.International journal of public health · 2024Pooled it
- Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review.Health policy (Amsterdam, Netherlands) · 2022Pooled it
- The impact of COVID-19 and catch-up strategies on routine childhood vaccine coverage trends in Latin America: A systematic literature review and database analysis.Human vaccines & immunotherapeutics · 2022Pooled it
- Epidemics, Lockdown Measures and Vulnerable Populations: A Mixed-Methods Systematic Review of the Evidence of Impacts on Mother and Child Health in Low-and Lower-Middle-Income Countries.International journal of health policy and management · 2022Pooled it
- Disruptions to routine childhood vaccinations in low- and middle-income countries during the COVID-19 pandemic: A systematic review.Frontiers in pediatrics · 2022Pooled it
- Pooled it
- Assessing the impact of polio supplementary immunisation activities on routine immunisation and health systems: a systematic review.BMJ global health · 2021Pooled it
- Impact of Enhanced Outreach Activities on Immunization Coverage in Pakistan: Evidence from Secondary Data Analysis (2011-2021).Vaccines · 2026Article
- Social networks and vaccination: a perspective on the essential role of social networks to improve vaccination outcomes in public health.Frontiers in public health · 2026Article
- Spatial analysis of meningococcal c vaccination coverage in children in BRAZIL between 2012 and 2024.BMC pediatrics · 2025Article
- A longitudinal study examining determinants of essential health services during the COVID-19 pandemic in regional referral hospitals across Uganda.Scientific reports · 2025Observational
- The Costs of Digital Health Interventions to Improve Immunization Data in Low- and Middle-Income Countries: Multicountry Mixed Methods Study.Journal of medical Internet research · 2025Article
- Child Immunization during COVID-19: A Mixed Methods Case Study of Pathanamthitta District, Kerala.Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine · 2025Article
- Regional difference on rotavirus vaccine coverage in children with diarrhea in Mozambique, before and during COVID-19 pandemic: a cross-sectional analysis.BMC infectious diseases · 2025Article
- Coverage, timeliness of measles immunisation and its predictors in Pakistan: an analysis of 6.2 million children enrolled in the Provincial Electronic Immunisation Registry.BMJ global health · 2025Article
- Association between contextual factors and vaccine coverage against human papilomavirus in adolescents in the state of Minas Gerais, Brazil: global spatial regressions.BMC infectious diseases · 2025Article
- Effect of COVID-19 pandemic on well child follow-up visits and vaccination: A Single unit experience from Turkey.Pakistan journal of medical sciences · 2025Article
- Article
- Missed Appointments and Associated Factors Among Children Accessing Anti-Retroviral Therapy During the COVID-19 Pandemic in South Western Uganda.HIV/AIDS (Auckland, N.Z.) · 2025Article
- Article
75 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCOVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan.
methodsWe extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression to explore the predictors associated with immunizations during the lockdown.
resultsThere was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Cal-mette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI: 1.04-1.15) and those with mothers having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program.
conclusionOne out of every two children in Sindh province has missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.
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