The Impact of Conflict on Immunisation Coverage in ۱۶ Countries
Publish Year: 1398
نوع سند: مقاله ژورنالی
زبان: English
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JR_HPM-8-4_004
تاریخ نمایه سازی: 18 مرداد 1403
Abstract:
Background Military conflict has been an ongoing determinant of inequitable immunisation coverage in many low- and middle-income countries, yet the impact of conflict on the attainment of global health goals has not been fully addressed. This review will describe and analyse the association between conflict, immunisation coverage and vaccine-preventable disease (VPD) outbreaks, along with country specific strategies to mitigate the impact in ۱۶ countries. Methods We cross-matched immunisation coverage and VPD data in ۲۰۱۴ for displaced and refugee populations. Data on refugee or displaced persons was sourced from the United Nations High Commissioner for Refugees (UNHCR) database, and immunisation coverage and disease incidence data from World Health Organization (WHO) databases. Demographic and Health Survey (DHS) databases provided additional data on national and sub-national coverage. The ۱۶ countries were selected because they had the largest numbers of registered UNHCR “persons of interest” and received new vaccine support from Global Alliance for Vaccine and Immunisation (GAVI), the Vaccine Alliance. We used national planning and reporting documentation including immunisation multiyear plans, health system strengthening strategies and GAVI annual progress reports (APRs) to assess the impact of conflict on immunisation access and coverage rates, and reviewed strategies developed to address immunisation program shortfalls in conflict settings. We also searched the peer-reviewed literature for evidence that linked immunisation coverage and VPD outbreaks with evidence of conflict. Results We found that these ۱۶ countries, representing just ۱۲% of the global population, were responsible for ۶۷% of global polio cases and ۳۹% of global measles cases between ۲۰۱۰ and ۲۰۱۵. Fourteen out of the ۱۶ countries were below the global average of ۸۵% coverage for diphtheria, pertussis, and tetanus (DPT۳) in ۲۰۱۴. We present data from countries where the onset of conflict has been associated with sudden drops in national and sub-national immunisation coverage. Tense security conditions, along with damaged health infrastructure and depleted human resources have contributed to infrequent outreach services, and delays in new vaccine introductions and immunisation campaigns. These factors have in turn contributed to pockets of low coverage and disease outbreaks in sub-national areas affected by conflict. Despite these impacts, there was limited reference to the health needs of conflict affected populations in immunisation planning and reporting documents in all ۱۶ countries. Development partner investments were heavily skewed towards vaccine provision and working with partner governments, with comparatively low levels of health systems support or civil partnerships. Conclusion Global and national policy and planning focus is required on the service delivery needs of conflict affected populations, with increased investment in health system support and civil partnerships, if persistent immunisation inequities in conflict affected areas are to be addressed.
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Authors
John Grundy
College of Public Health, Medical and Veterinary Services, Cairns Campus, James Cook University, Douglas, QLD, Australia
Beverley-Ann Biggs
Department of Medicine, Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
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