Freetown — Although the first case of COVID-19 didn't emerge until late in March in Sierra Leone, by late April, immunization rates and the use of child health care services had worryingly declined by about 19%.
Mothers like Hawa Dumbuya feared making visits to a health facility, because they were concerned that with COVID-19 circulating by doing so they would put themselves and their children in harm's way.
"I was afraid that going to the health facility would expose us to coronavirus," Dumbuya admits.
The Ministry of Health and Sanitation moved quickly to stem the growing anxieties and reverse the avoidance of critical child health care services.
Working with district communications unit staff and in collaboration with UNICEF and the World Health Organization (WHO), the Ministry ramped up public health messaging through radio stations. The informative announcements, played nationwide, urged mothers and caregivers to continue taking their children to health centres for the routine immunizations.
These messages gave parents like Dambuya reassurance to take her baby, born in May, to her local health facility and to check on her own health. "Coming for delivery was a difficult decision because of the fear of COVID-19, but it was good that I was brought here," says Dambuya.
"As we learned more about the disease and how to stay safe, it gave me courage to continue to seek health services while using a mask and other preventive measures," she says. "I came for vaccine for my child, and she was vaccinated. We mothers were reminded to sit apart and to use our mask properly. And the nurses were also fully masked up. So that was reassuring."
The Ministry also ensured that vaccines were available at the district level with no depletion, which would have discouraged health facility attendance by parents and caregivers. The Ministry aggressively safeguarded supplies to guarantee that all immunizations would be available for anyone seeking them.
"First of all, we made sure there was a sufficient stock of vaccines in the country. Then we monitored the distribution to public health facilities. We also monitored service utilization by collecting and analysing data and providing feedback to the districts on their performance," explains Dr Tom Sesay, Manager of the Ministry's Expanded Programme on Immunization.
COVID-19 has imposed challenges to maintaining immunization and child health care services. The WHO Sierra Leone country office has escalated its technical assistance, with all immunization staff deployed to the field to help integrate immunization activities into the COVID-19 response, particularly at health facilities.
To raise awareness of the need for continuity of immunization and essential child health care services, WHO also deployed integrated supportive supervision teams and STOP polio consultants, to draw on their years of community outreach experience and knowledge.
Dr Thompson Igbu, who heads the WHO Sierra Leone Expanded Programme on Immunization team, emphasizes the importance of this continuity: "One of the most cost-effective public health interventions is vaccination because it protects a lot of children. In Sierra Leone, we have 12 antigens in the routine immunization system. Providing this service regularly to every eligible child means we are able to prevent illnesses that would have otherwise occurred if those children were not protected."
The quick antidote to the heightened anxieties and disruptions to the routine immunization regimen among the general public is paying off. The rates of immunization are beginning to return to the pre-COVID-19 levels of 90% for the third dose of pentavalent vaccine, which is administered at 6 weeks, 10 weeks and 14 weeks of age. The pentavalent vaccine gives protection against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenza type b (Hib).
The next step is to offer families catch-up vaccination campaigns, complete with all infection prevention and control measures - physical distancing, face masks, hand hygiene.
Dr Igbu, like every public health professional, knows only too well how even the smallest interruption to the routine immunization of children can have widespread negative impact for families and communities. "A sick child is unable to attend school or play actively, and the caregiver has to take time from work to care for the child's health and buy medicines," he says. "This contributes to increasing household expenditures and reduces the family funds that would be available for other things. Disease outbreaks can occur easily. Going unchecked, it will have a lot of negative impacts on society."