Vaccination coverage in rural Burkina Faso under the effects of COVID-19: evidence from a panel study in eight districts

BackgroundImproving infant immunization completion and promoting equitable vaccination coverage are crucial to reducing global under-5 childhood mortality. Although there have been hypotheses that the impact of the COVID-19 pandemic would decrease the delivery of health services and immunization campaigns in low- and middle-income countries, the available evidence is still inconclusive. We conducted a study in rural Burkina Faso to assess changes in vaccination coverage during the pandemic. A secondary objective was to examine long-term trends in vaccination coverage throughout 2010-2021.MethodsUsing a quasi-experimental approach, we conducted three rounds of surveys (2019, 2020, 2021) in rural Burkina Faso that we pooled with two previous rounds of demographic and household surveys (2010, 2015) to assess trends in vaccination coverage. The study population comprised infants aged 0-13 months from a sample of 325 households randomly selected in eight districts (n = 736). We assessed vaccination coverage by directly observing the infants' vaccination booklet. Effects of the pandemic on infant vaccination completion were analyzed using multi-level logistic regression models with random intercepts at the household and district levels.ResultsA total of 736 child-year observations were included in the analysis. The proportion of children with age-appropriate complete vaccination was 69.76% in 2010, 55.38% in 2015, 50.47% in 2019-2020, and 64.75% in 2021. Analyses assessing changes in age-appropriate full-vaccination coverage before and during the pandemic show a significant increase (OR: 1.8, 95% CI: 1.14-2.85). Our models also confirmed the presence of heterogeneity in full vaccination between health administrative districts. The pandemic could have increased inequities in infant vaccination completion between these districts. The analyses suggest no disruption in age-appropriate full vaccination due to COVID-19. Our findings from our sensitivity analyses to examine trends since 2010 did not show any steady trends.ConclusionOur findings in Burkina Faso do not support the predicted detrimental effects of COVID-19 on the immunization schedule for infants in low- and middle-income countries. Analyses comparing 2019 and 2021 show an improvement in age-appropriate full vaccination. Regardless of achieving and sustaining vaccination coverage levels in Burkina Faso, this should remain a priority for health systems and political agendas. Our study reveals an increase in vaccination coverage during the pandemic in Burkina Faso, contrary to prior research that reported or predicted decreases in routine immunization coverage. This cautions for a more nuanced understanding of the COVID-19 pandemic's effects.Vaccination coverage varies widely and increasingly between districts. The increase in the number of vaccines and supply difficulties in some areas during the pandemic have potentially contributed to this.Policy- and decision-makers should prioritize considering local contextual factors that could influence vaccination coverage, as suggested by the significant disparities across districts in rural Burkina Faso.

Automated summary

This study conducted in rural Burkina Faso assessed changes in vaccination coverage during the COVID-19 pandemic and examined long-term trends in vaccination coverage from 2010 to 2021. The findings suggest that the impact of the pandemic on infant immunization was not as detrimental as predicted.