Effects of Covid 19 on the Accessibility of Routine Immunisation Services in Harare City, Zimbabwe

Abstract

Childhood routine immunisation service accessibility during pandemics is a worrying global problem that disrupts progress in the fight against Vaccine Preventable Diseases (VPDs). The decrease of immunisation coverage during pandemics indicates a high risk of child morbidity and mortality from vaccine preventable deaths. This study sought to establish the compliance level and uncover the reasons and barriers for late access to immunization appointments during the Covid 19 pandemic in Harare City Family Health Service clinics (FHS). A cross-sectional analytical study design was used to explore the determinants of immunisation service accessibility in Harare City Family Health Services clinics. Primary data was collected from caregivers of under five children who accessed immunisation services in Harare Family Health Service clinics and questionnaires were administered to 273 study participants. A convenient and simple random sampling technique was used to select study participants. Data were analysed using Epi Info version 7. Descriptive statistics were based on frequencies and percentages. Chi-square test, bivariate and multivariate analysis were used for analytical statistics. The median age of the participants was 34. Level of compliance to scheduled immunisation services indicated that majority 158 (58%) of the under-five’s caregivers reported late and 115 (42%) reported on time for immunisation appointments. Socio-demographic characteristics that were found to be significantly associated with delayed utilisation of immunisation services were: age (x2 = 25.3, p ˂0.001) and place of residents (x2 = 47.7, p˂0.001), multivariate analysis results of socio-demographic characteristics associated with late access were: age 50+ years (AOR 8.0; p=0.003) and residing in Mabvuku (AOR 16.6, p˂0.001) and Mufakose (AOR 11.8, p˂0.001). Sociodemographic characteristics such as sex, religion, marital status, employment status were not found to be associated with access to immunization services (p>0.050). A significant association between late immunisation and service delivery factors was noticed: experiences at health facilities (AOR=2.7, p=0.018), shortage of healthcare staff (AOR=2.8, p=0.023), vaccine stock outs (AOR=2.5, p=0.037) suspension of health facilities (AOR=2.1, p=0.032) and waiting time (AOR= 2.8, p=0.018). The association between late access to immunisation services and caregivers’ concerns were significantly determined by Covid 19 regulations (AOR 2.3, p=0.015), fear to contract Covid 19 (AOR 4.8, p˂0.001), shortage of transport (AOR 2.8, p=0.028) and use of public transport (AOR 0.2, p=0.002). During the Covid 19 pandemic, caregivers encountered challenges in accessing immunisation services at FHS clinics. Therefore, the study recommends Harare City Health Department to introduce immunisation home visits during pandemics.