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Boisson-Walsh A, Thompson P, Fried B, Shea CM, Ngimbi P, Lumande F, Tabala M, Kashamuka MM, Babakazo P, Domino ME, Yotebieng M. Childhood immunization uptake determinants in Kinshasa, Democratic Republic of the Congo: ordered regressions to assess timely infant vaccines administered at birth and 6-weeks. Glob Health Res Policy 2023; 8:50. [PMID: 38057919 PMCID: PMC10698958 DOI: 10.1186/s41256-023-00338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Despite global efforts to reduce preventable childhood illness by distributing infant vaccines, immunization coverage in sub-Saharan African settings remains low. Further, timely administration of vaccines at birth-tuberculosis (Bacille Calmette-Guérin [BCG]) and polio (OPV0)-remains inconsistent. As countries such as Democratic Republic of the Congo (DRC) prepare to add yet another birth-dose vaccine to their immunization schedule, this study aims to improve current and future birth-dose immunization coverage by understanding the determinants of infants receiving vaccinations within the national timeframe. METHODS The study used two ordered regression models to assess barriers to timely BCG and first round of the hepatitis B (HepB3) immunization series across multiple time points using the Andersen Behavioral Model to conceptualize determinants at various levels. The assessment leveraged survey data collected during a continuous quality improvement study (NCT03048669) conducted in 105 maternity centers throughout Kinshasa Province, DRC. The final sample included 2398 (BCG analysis) and 2268 (HepB3 analysis) women-infant dyads living with HIV. RESULTS Between 2016 and 2020, 1981 infants (82.6%) received the BCG vaccine, and 1551 (68.4%) received the first dose of HepB3 vaccine. Of those who received the BCG vaccine, 26.3%, 43.5%, and 12.8% received BCG within 24 h, between one and seven days, and between one and 14 weeks, respectively. Of infants who received the HepB3 vaccine, 22.4% received it within six weeks, and 46% between six and 14 weeks of life. Many factors were positively associated with BCG uptake, including higher maternal education, household wealth, higher facility general readiness score, and religious-affiliated facility ownership. The factors influencing HepB3 uptake included older maternal age, higher education level, household wealth, transport by taxi to a facility, higher facility general and immunization readiness scores, and religious-affiliated facility ownership. CONCLUSIONS This study demonstrated that the study participants' uptake of vaccines was consistent with the country average, but not in a timely manner. Various factors were associated with timely uptake of BCG and HepB3 vaccines. These findings suggest that investment to strengthen the vaccine delivery system might improve timely vaccine uptake and equity in vaccine coverage.
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Affiliation(s)
- Alix Boisson-Walsh
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA.
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Bruce Fried
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Christopher Michael Shea
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Patrick Ngimbi
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Fidéle Lumande
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Martine Tabala
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Pélagie Babakazo
- Ecole de Santé Publique de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marisa Elaine Domino
- Center for Health Information and Research, College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, Portnoy A, Vynnycky E, Woodruff K, Ferguson NM, Toor J, Gaythorpe KAM. Vaccine equity in low and middle income countries: a systematic review and meta-analysis. Int J Equity Health 2022; 21:82. [PMID: 35701823 PMCID: PMC9194352 DOI: 10.1186/s12939-022-01678-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in immunisation coverage and impact, i.e. the number of cases, deaths, and disability-adjusted life years averted. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies. METHODS A systematic review of two databases (PubMed and Web of Science) was undertaken using search terms and keywords to identify studies examining factors on immunisation inequality and heterogeneity in vaccination coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic. RESULTS One hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccination dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest. CONCLUSIONS We found a nuanced picture of inequality in vaccination coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic. TRIAL REGISTRATION Prospero, CRD42021261927.
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Affiliation(s)
- Huda Ahmed Ali
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Anna-Maria Hartner
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | | | - Jeremy Roth
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Xiang Li
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Kaja Abbas
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Allison Portnoy
- grid.38142.3c000000041936754XCenter for Health Decision Science, Harvard T H Chan School of Public Health, Cambridge, USA
| | - Emilia Vynnycky
- grid.271308.f0000 0004 5909 016XPublic Health England, London, UK
| | - Kim Woodruff
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Neil M Ferguson
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Jaspreet Toor
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Katy AM Gaythorpe
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
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Alonso S, Vidal M, Ruiz-Olalla G, González R, Manaca MN, Jairoce C, Vázquez-Santiago M, Balcells R, Vala A, Rupérez M, Cisteró P, Fuente-Soro L, Cova M, Angov E, Nhacolo A, Sevene E, Aponte JJ, Macete E, Aguilar R, Mayor A, Menéndez C, Dobaño C, Moncunill G. Reduced Placental Transfer of Antibodies Against a Wide Range of Microbial and Vaccine Antigens in HIV-Infected Women in Mozambique. Front Immunol 2021; 12:614246. [PMID: 33746958 PMCID: PMC7965965 DOI: 10.3389/fimmu.2021.614246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/08/2021] [Indexed: 01/16/2023] Open
Abstract
Transplacental transfer of antibodies is essential for conferring protection in newborns against infectious diseases. We assessed the impact of different factors, including gestational age and maternal infections such as HIV and malaria, on the efficiency of cord blood levels and placental transfer of IgG subclasses. We measured total IgG and IgG subclasses by quantitative suspension array technology against 14 pathogens and vaccine antigens, including targets of maternal immunization, in 341 delivering HIV-uninfected and HIV-infected mother-infant pairs from southern Mozambique. We analyzed the association of maternal HIV infection, Plasmodium falciparum exposure, maternal variables and pregnancy outcomes on cord antibody levels and transplacental transfer. Our results show that maternal antibody levels were the main determinant of cord antibody levels. Univariable and multivariable analysis showed that HIV reduced the placental transfer and cord levels of IgG and IgG1 principally, but also IgG2 to half of the antigens tested. P. falciparum exposure and prematurity were negatively associated with cord antibody levels and placental transfer, but this was antigen-subclass dependent. Our findings suggest that lower maternally transferred antibodies may underlie increased susceptibility to infections of HIV-exposed infants. This could affect efficacy of maternal vaccination, especially in sub-Saharan Africa, where there is a high prevalence of HIV, malaria and unfavorable environmental factors.
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Affiliation(s)
- Selena Alonso
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Marta Vidal
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Gemma Ruiz-Olalla
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - M. Nelia Manaca
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Chenjerai Jairoce
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Reyes Balcells
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anifa Vala
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - María Rupérez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pau Cisteró
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Laura Fuente-Soro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Marta Cova
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Evelina Angov
- U.S. Military Malaria Vaccine Program, Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD, United States
| | - Arsenio Nhacolo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Esperança Sevene
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Department of Physiologic Science, Clinical Pharmacology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - John J. Aponte
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ruth Aguilar
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alfredo Mayor
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Carlota Dobaño
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Gemma Moncunill
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Pediatric HIV Care Cascade in Southern Mozambique: Missed Opportunities for Early ART and Re-engagement in Care. Pediatr Infect Dis J 2020; 39:429-434. [PMID: 32091497 DOI: 10.1097/inf.0000000000002612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are 170,000 children living with HIV in 2017 in Mozambique. Scaling-up HIV care requires effective retention along the cascade. We sought to evaluate the pediatric cascade in HIV care at the Manhiça District Hospital. METHODS A prospective cohort of children <15 years was followed from enrollment in HIV care (January 2013 to December 2015) until December 2016. Loss to follow-up (LTFU) was defined as not attending the HIV hospital visits for ≥90 days following last visit attended. RESULTS From the 438 children included {median age at enrollment in care of 3,6 [interquartile range (IQR): 1.1-8.6] years}, 335 (76%) were antiretroviral therapy (ART) eligible and among those, 263 (78%) started ART at enrollment in HIV care. A total of 362 children initiated ART during the study period and the incidence rate of LTFU at 12, 24, and 36 months post-ART initiation was 41 [95% confidence interval (CI): 34-50], 34 (95% CI: 29-41), and 31 (95% CI: 27-37) per 100 children-years, respectively. Median time to LTFU was 5.8 (IQR: 1.4-12.7) months. Children 5-9 years of age had a lower risk of LTFU compared with children <1 year [adjusted subhazard ratio 0.36 (95% CI: 0.20-0.61)]. Re-engagement in care (RIC) was observed in 25% of the LTFU children. CONCLUSIONS The high LTFU found in this study highlights the special attention that should be given to younger children during the first 6 months post-ART initiation to prevent LTFU. Once LTFU, only a quarter of those children return to the health unit. Elucidating factors associated with RIC could help to fine tune interventions which promote RIC.
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Coverage and Determinants of Full Immunization: Vaccination Coverage among Senegalese Children. ACTA ACUST UNITED AC 2019; 55:medicina55080480. [PMID: 31416213 PMCID: PMC6723170 DOI: 10.3390/medicina55080480] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/27/2019] [Accepted: 08/09/2019] [Indexed: 11/27/2022]
Abstract
Background and Objectives: In line with the global success of immunization, Senegal achieved impressive progress in childhood immunization program. However, immunization coverage is often below the national and international targets and even not equally distributed across the country. The objective of this study is to estimate the full immunization coverage across the geographic regions and identify the potential factors of full immunization coverage among the Senegalese children. Materials and Methods: Nationally representative dataset extracted from the latest Continuous Senegal Demographic and Health Survey 2017 was used for this analysis. Descriptive statistics such as the frequency with percentage and multivariable logistic regression models were constructed and results were presented in terms of adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results: Overall, 70.96% of Senegalese children aged between 12 to 36 months were fully immunized and the coverage was higher in urban areas (76.51%), west ecological zone (80.0%), and among serer ethnic groups (77.24%). Full immunization coverage rate was almost the same between male and female children, and slightly higher among the children who were born at any health care facility (74.01%). Children who lived in the western zone of Senegal were 1.66 times (CI: 1.25–2.21; p = 0.001) and the children of Serer ethnic groups were 1.43 times (CI: 1.09–1.88; p = 0.011) more likely to be fully immunized than the children living in the southern zone and from the Poular ethnic group. In addition, children who were born at health facilities were more likely to be fully immunized than those who were born at home (AOR = 1.47; CI: 1.20–1.80; p < 0.001), and mothers with recommended antenatal care (ANC) (4 and more) visits during pregnancy were more likely to have their children fully immunized than those mother with no ANC visits (AOR: 2.06 CI: 1.19–3.57; p = 0.010). Conclusions: Immunization coverage was found suboptimal by type of vaccines and across ethnic groups and regions of Senegal. Immunization program should be designed targeting low performing areas and emphasize on promoting equal access to education, decision-making, encouraging institutional deliveries, and scaling up the use of antenatal and postnatal care which may significantly improve the rate full immunization coverage in Senegal.
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Sarker AR, Akram R, Ali N, Sultana M. Coverage and factors associated with full immunisation among children aged 12-59 months in Bangladesh: insights from the nationwide cross-sectional demographic and health survey. BMJ Open 2019; 9:e028020. [PMID: 31289076 PMCID: PMC6629384 DOI: 10.1136/bmjopen-2018-028020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the coverage and factors associated with full immunisation coverage among children aged 12-59 months in Bangladesh. STUDY DESIGN The study is cross sectional in design. Secondary dataset from Bangladesh Demographic and Health Survey was used for this analysis. Immunisation status was categorised as 'fully immunised' if the children had received all the eight recommended vaccine doses otherwise 'partially/unimmunised'. SETTINGS Bangladesh. PARTICIPANT Children aged 12-59 months were the study participants. Participants were randomly selected through a two-stage stratified sampling design. A total of 6230 children were eligible for the analysis. RESULTS About 86% of the children (5356 out of 6230) were fully immunised. BCG has the highest coverage rate (97.1%) followed by oral polio vaccine 1 (97%) and pentavalent 1 (96.6%), where the coverage rate was the lowest for measles vaccine (88%). Coverage was higher in urban areas (88.5%) when compared with rural ones (85.1%). Full immunisation coverage was significantly higher among children who lived in the Rangpur division (adjusted OR (AOR)=3.46; 95% CI 2.45 to 4.88, p<0.001), were 48-59 months old (AOR=1.32; 95% CI 1.06 to 1.64, p=0.013), lived in a medium size family (AOR=1.56; 95% CI 1.32 to 1.86, p<0.001), had parents with a higher level of education (AOR=1.96; 95% CI 1.21 to 3.17, p=0.006 and AOR=1.55; 95% CI 1.05 to 2.29, p=0.026) and belonged to the richest families (AOR=2.2; 95% CI 1.5 to 3.21, p<0.001). The likelihood of being partially or unimmunised was higher among children who had the father as their sole healthcare decision-maker (AOR=0.69; 95% CI 0.51 to 0.92, p<0.012). CONCLUSIONS There were significant variations of child immunisation coverage across socioeconomic and demographic factors. These findings will inform innovative approaches for immunisation programmes, and the introduction of relevant policies, including regular monitoring and evaluation of immunisation coverage-particularly for low-performing regions, so that the broader benefit of immunisation programmes can be achieved in all strata of the society.
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Affiliation(s)
- Abdur Razzaque Sarker
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Raisul Akram
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Nausad Ali
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
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Marbán-Castro E, Sacoor C, Nhacolo A, Augusto O, Jamisse E, López-Varela E, Casellas A, Aponte JJ, Bassat Q, Sigauque B, Macete E, Garcia-Basteiro AL. BCG vaccination in southern rural Mozambique: an overview of coverage and its determinants based on data from the demographic and health surveillance system in the district of Manhiça. BMC Pediatr 2018; 18:56. [PMID: 29439702 PMCID: PMC5811981 DOI: 10.1186/s12887-018-1003-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 01/23/2018] [Indexed: 12/29/2022] Open
Abstract
Background Over the past four decades, the World Health Organization established the Expanded Programme on Immunization (EPI) to foster universal access to all relevant vaccines for all children at risk. The success of this program has been undeniable, but requires periodic monitoring to ensure that coverage rates remain high. The aim of this study was to measure the BCG vaccination coverage in Manhiça district, a high TB burden rural area of Southern Mozambique and to investigate factors that may be associated with BCG vaccination. Methods We used data from the Health and Demographic Surveillance System (HDSS) run by the Manhiça Health Research Centre (CISM) in the district of Manhiça. A questionnaire was added in the annual HDSS round visits to retrospectively collect the vaccination history of children under the age of 3 years. Vaccinations are registered in the National Health Cards which are universally distributed at birth. This information was collected for children born from 2011 to 2014. Data on whether a child was vaccinated for BCG were collected from these National Health Cards and/or BCG scar assessment. Results A total of 10,875 number of children were eligible for the study and 7903 presented the health card. BCG coverage was 97.4% for children holding a health card. A BCG-compatible scar was observed in 99.0% of all children and in 99.6% of children with recorded BCG in the card. A total of 93.4% of children had been vaccinated with BCG within their first 28 days of life. None of the factors analysed were found to be associated with lack of BCG vaccination except for living in the municipality of Maluana compared to living in the municipality of Manhiça; (OR = 1.89, 95% CI: 1.18-3.00). Coverage for other EPI vaccines during the first year of life was similarly high, but decreased for subsequent doses. Conclusions BCG coverage is high and timely administered. Almost all vaccinated infants develop scar, which is a useful proxy for monitoring BCG vaccine implementation. Electronic supplementary material The online version of this article (10.1186/s12887-018-1003-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Ariel Nhacolo
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Orvalho Augusto
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Edgar Jamisse
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Elisa López-Varela
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain.,Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Aina Casellas
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain
| | - John J Aponte
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain.,Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain.,Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique.,ICREA, Pg. Lluís Companys 23, 08010, Barcelona, Spain
| | - Betuel Sigauque
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique
| | - Alberto L Garcia-Basteiro
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, C/Rosselló 132, 08036, Barcelona, Spain. .,Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila de Manhiça, CP 1929, Maputo, Mozambique. .,Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.
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Abstract
OBJECTIVES Despite the adoption of WHO's Expanded Programme on Immunisation in Indonesia since 1977, a large proportion of children are still completely unimmunised or only partly immunised. This study aimed to assess factors associated with low immunisation coverage of children in Indonesia. SETTING Children aged 12-59 months in Indonesia. PARTICIPANT The socioeconomic characteristics and immunisation status of the children were obtained from the most recent Demographic and Health Survey, the 2012 Indonesia Demographic and Health Survey. Participants were randomly selected through a two-stage stratified sampling design. Data from 14 401 children aged 12-59 months nested within 1832 census blocks were included in the analysis. Multilevel logistic regression models were constructed to account for hierarchical structure of the data. RESULTS The mean age of the children was 30 months and they were equally divided by sex. According to the analysis, 32% of the children were fully immunised in 2012. Coverage was significantly lower among children who lived in Maluku and Papua region (adjusted OR: 1.94; 95% CI 1.42 to 2.64), were 36-47 months old (1.39; 1.20 to 1.60), had higher birth order (1.68; 1.28 to 2.19), had greater family size (1.47; 1.11 to 1.93), whose mother had no education (2.13; 1.22 to 3.72) and from the poorest households (1.58; 1.26 to 1.99). The likelihood of being unimmunised was also higher among children without health insurance (1.16; 1.04 to 1.30) and those who received no antenatal (3.28; 2.09 to 5.15) and postnatal care (1.50; 1.34 to 1.69). CONCLUSIONS Socioeconomic factors were strongly associated with the likelihood of being unimmunised in Indonesia. Unimmunised children were geographically clustered and lived among the most deprived population. To achieve WHO target of protective coverage, public health interventions must be designed to meet the needs of these high-risk groups.
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Affiliation(s)
- Putri Herliana
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Abdel Douiri
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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Samiak L, Emeto TI. Vaccination and nutritional status of children in Karawari, East Sepik Province, Papua New Guinea. PLoS One 2017; 12:e0187796. [PMID: 29121088 PMCID: PMC5679557 DOI: 10.1371/journal.pone.0187796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 10/26/2017] [Indexed: 11/21/2022] Open
Abstract
Delivery of health care services to rural and remote populations in Papua New Guinea (PNG) is problematic. This is mainly due to difficulties with transportation and communication. Hence, the children in this region of PNG are likely to be at risk of malnutrition compounded by inadequate vaccination that may predispose them to preventable diseases. This study was conducted to determine the vaccination and nutritional status of children less than 5 years old in the remote and rural Karawari area of PNG. 105 children were included in the study, of whom 55% were male and 45% female. The mean age of children included in the study was 32.6 months. Their age, height, and weight by gender was not significantly different. Overall, 85% of children had incomplete vaccination. However, children above the median age of 32 months (34%) were more likely to be fully vaccinated for their age, χ2 (1) = 23.294, p < 0.005. In addition, 25% of children were below the -1 SD (Z-scores) for weight-for—height, 33% below the -1 SD for weight-for-age, and 25.5% below the -1 SD for height-for-age compared to WHO standards. A large proportion of children had poor nutrition status and lack protection from vaccine preventable diseases. This study recommends that the government should introduce a surveillance system for detecting issues of importance to the rural majority. We also recommend that the PNG government reopen the nearby health centre, and/ or establish new facilities within the region, with adequately trained and compensated staff.
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Affiliation(s)
- Louis Samiak
- Department of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Theophilus I. Emeto
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- * E-mail:
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10
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Shemwell SA, Peratikos MB, González-Calvo L, Renom-Llonch M, Boon A, Martinho S, Cherry CB, Green AF, Moon TD. Determinants of full vaccination status in children aged 12-23 months in Gurùé and Milange districts, Mozambique: results of a population-based cross-sectional survey. Int Health 2017; 9:234-242. [PMID: 28810665 PMCID: PMC5881253 DOI: 10.1093/inthealth/ihx020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/01/2017] [Accepted: 06/06/2017] [Indexed: 11/12/2022] Open
Abstract
Background In 2011, 64% of children in Mozambique, ages 12-23 months, were fully immunized. Large provincial differences in vaccine uptake exist. Methods We conducted a survey of 1650 females with children aged 12-23 months in the districts of Gurùé and Milange. Implementation occurred from November to December 2014. Descriptive statistics and logistic regression using R-software 3.0.2 were used to examine factors associated with full vaccination status. ArcGIS version 10.3.1 (ESRI, Redlands, CA, USA) was used to map spatial patterns of vaccine uptake. Results Full vaccination was roughly 48%. Identifying 'hospital' as a location to get vaccinated was associated with having a fully vaccinated child (OR=1.87, 95% CI=1.02, 3.41, p=0.043). Households where health decisions are made solely by the male or the female had 38% (95% CI=0.32, 1.21) and 55% (95% CI=0.29, 0.69) lower odds, respectively, of their child being fully immunized. For every 10 km increase from the nearest health facility there was a 36% lower odds of the child being fully immunized (OR=0.64, 95% CI=0.44, 0.93, p<0.001). Conclusion Zambézia Province, as a whole and the districts of Gurùé and Milange specifically, is falling short of vaccination targets. Intensified efforts focused on the least educated, most distant and which take a more family-centered approach are needed to improve vaccine uptake.
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Affiliation(s)
- Shellese A. Shemwell
- Vanderbilt Institute for Global Health, 2525 West End Avenue Suite 725, Nashville, Tennessee, USA, 37203
| | - Meridith B. Peratikos
- Vanderbilt Institute for Global Health, 2525 West End Avenue Suite 725, Nashville, Tennessee, USA, 37203
- Department of Biostatistics, Vanderbilt University Medical Center 2525 West End Avenue Suite 11000, Nashville, Tennessee, USA, 37203
| | - Lázaro González-Calvo
- Vanderbilt Institute for Global Health, 2525 West End Avenue Suite 725, Nashville, Tennessee, USA, 37203
- Friends in Global Health, Avenida dos Trabalhadores #32, Maputo, Mozambique
| | | | - Alexandre Boon
- UNICEF, Health & Nutrition Section, Avenida do Zimbabwe, Maputo, Mozambique
| | - Samuel Martinho
- Friends in Global Health, Avenida dos Trabalhadores #32, Maputo, Mozambique
| | - Charlotte B. Cherry
- Vanderbilt Institute for Global Health, 2525 West End Avenue Suite 725, Nashville, Tennessee, USA, 37203
| | - Ann F. Green
- Vanderbilt Institute for Global Health, 2525 West End Avenue Suite 725, Nashville, Tennessee, USA, 37203
- Friends in Global Health, Avenida dos Trabalhadores #32, Maputo, Mozambique
| | - Troy D. Moon
- Vanderbilt Institute for Global Health, 2525 West End Avenue Suite 725, Nashville, Tennessee, USA, 37203
- Friends in Global Health, Avenida dos Trabalhadores #32, Maputo, Mozambique
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Ave S #D7235, Nashville, Tennessee, USA, 37203
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11
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López-Varela E, L. García-Basteiro A, Augusto OJ, Fraile O, Bulo H, Ira T, Gondo K, van Ingen J, Naniche D, Sacarlal J, Alonso PL. High Rates of Non-Tuberculous Mycobacteria Isolation in Mozambican Children with Presumptive Tuberculosis. PLoS One 2017; 12:e0169757. [PMID: 28095429 PMCID: PMC5240942 DOI: 10.1371/journal.pone.0169757] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/21/2016] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Non-tuberculous mycobacteria (NTM) can cause disease which can be clinically and radiologically undistinguishable from tuberculosis (TB), posing a diagnostic and therapeutic challenge in high TB settings. We aim to describe the prevalence of NTM isolation and its clinical characteristics in children from rural Mozambique. METHODS This study was part of a community TB incidence study in children <3 years of age. Gastric aspirate and induced sputum sampling were performed in all presumptive TB cases and processed for smear testing using fluorochrome staining and LED Microscopy, liquid and solid culture, and molecular identification by GenoType® Mycobacterium CM/AS assays. RESULTS NTM were isolated in 26.3% (204/775) of children. The most prevalent NTM species was M. intracellulare (N = 128), followed by M. scrofulaceum (N = 35) and M. fortuitum (N = 9). Children with NTM were significantly less symptomatic and less likely to present with an abnormal chest radiograph than those with M. tuberculosis. NTM were present in 21.6% of follow-up samples and 25 children had the same species isolated from ≥2 separate samples. All were considered clinically insignificant and none received specific treatment. Children with NTM isolates had equal all cause mortality and likelihood of TB treatment as those with negative culture although they were less likely to have TB ruled out. CONCLUSIONS NTM isolation is frequent in presumptive TB cases but was not clinically significant in this patient cohort. However, it can contribute to TB misdiagnosis. Further studies are needed to understand the epidemiology and the clinical significance of NTM in children.
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Affiliation(s)
- Elisa López-Varela
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alberto L. García-Basteiro
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
| | | | - Oscar Fraile
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Helder Bulo
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Tasmiya Ira
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Kizito Gondo
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Denise Naniche
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jahit Sacarlal
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- Departamento de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Pedro L. Alonso
- Centro de Investigação em Saude de Manhiça (CISM), Maputo, Mozambique
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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