Abstract
BackgroundSierra Leone has undergone a decade of civil war from 1991 to 2001. From this period few data on immunization coverage are available, and conflict-related delays in immunization according to the Expanded Programme on Immunization (EPI) schedule have not been investigated. We aimed to study delays in childhood immunization in the context of civil war in a Sierra Leonean community.MethodsWe conducted an immunization survey in Kissy Mess-Mess in the Greater Freetown area in 1998/99 using a two-stage sampling method. Based on immunization cards and verbal history we collected data on immunization for tuberculosis, diphtheria, tetanus, pertussis, polio, and measles by age group (0–8/9–11/12–23/24–35 months). We studied differences between age groups and explored temporal associations with war-related hostilities taking place in the community.ResultsWe included 286 children who received 1690 vaccine doses; card retention was 87%. In 243 children (85%, 95% confidence interval (CI): 80–89%) immunization was up-to-date. In 161 of these children (56%, 95%CI: 50–62%) full age-appropriate immunization was achieved; in 82 (29%, 95%CI: 24–34%) immunization was not appropriate for age. In the remaining 43 children immunization was partial in 37 (13%, 95%CI: 9–17) and absent in 6 (2%, 95%CI: 1–5). Immunization status varied across age groups. In children aged 9–11 months the proportion with age-inappropriate (delayed) immunization was higher than in other age groups suggesting an association with war-related hostilities in the community.ConclusionOnly about half of children under three years received full age-appropriate immunization. In children born during a period of increased hostilities, immunization was mostly inappropriate for age, but recommended immunizations were not completely abandoned. Missing or delayed immunization represents an additional threat to the health of children living in conflict areas.
Highlights
Sierra Leone has undergone a decade of civil war from 1991 to 2001 characterised by military action targeted against civilians, including many children [1]
The immunization status and delays in immunization varied across age groups, and temporal associations with war-related events in the community could be identified
We found a low proportion of children with full ageappropriate immunization in a Sierra Leonean community exposed to war-related hostilities while up-to-date immunization was maintained
Summary
Sierra Leone has undergone a decade of civil war from 1991 to 2001. From this period few data on immunization coverage are available, and conflict-related delays in immunization according to the Expanded Programme on Immunization (EPI) schedule have not been investigated. We aimed to study delays in childhood immunization in the context of civil war in a Sierra Leonean community. Sierra Leone has undergone a decade of civil war from 1991 to 2001 characterised by military action targeted against civilians, including many children [1]. Eight years after the Lomé Peace Agreement, Sierra Leone is today amongst the countries with the greatest shortfall in development [4]. In 2000, about 17% of Sierra Leone's population of 4.5 million were under five years old [5]
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