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Price O, Swanton R, Grebely J, Hajarizadeh B, Webb P, Peacock A, Dore GJ, Cowie BC, Vickerman P, Degenhardt L. Vaccination coverage among people who inject drugs: A systematic review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104382. [PMID: 38503233 DOI: 10.1016/j.drugpo.2024.104382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND People who inject drugs may be at excess risk of acquiring vaccine-preventable diseases and negative associated health outcomes, but experience barriers to vaccination. We aimed to determine vaccination coverage among people who inject drugs globally. METHODOLOGY We conducted systematic searches of the peer-reviewed and grey literature, date limited from January 2008 to August 2023, focusing on diseases for which people who inject drugs are at elevated risk for and for which an adult vaccination dose is recommended (COVID-19, hepatitis A, hepatitis B, human papillomavirus, influenza, pneumococcal disease, tetanus). To summarise available data, we conducted a narrative synthesis. RESULTS We included 78 studies/reports comprising 117 estimates of vaccination coverage across 36 countries. Most estimates were obtained from high income countries (80%, n=94). We located estimates for hepatitis B vaccination in 33 countries, which included 18 countries with data on serological evidence of vaccine-derived hepatitis B immunity (range: 6-53%) and 22 countries with self-report data for vaccine uptake (<1-96%). Data for other vaccines were scarcer: reported hepatitis A vaccination coverage ranged 3-89% (five countries), COVID-19 ranged 4-84% (five countries), while we located estimates from fewer than five countries for influenza, tetanus, pneumococcal disease, and human papillomavirus. CONCLUSION Estimates were sparse but where available indicative of suboptimal vaccination coverage among people who inject drugs. Improving the consistency, timeliness, and geographic coverage of vaccine uptake data among this population is essential to inform efforts to increase uptake.
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Affiliation(s)
- Olivia Price
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
| | - Rosie Swanton
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | | | | | - Paige Webb
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | | | - Benjamin C Cowie
- Department of Infectious Diseases, University of Melbourne, Melbourne, Australia; WHO Collaborating Centre for Viral Hepatitis, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter Vickerman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
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Akanpaabadai EA, Adiak AA, Nukpezah RN, Adokiya MN, Adjei SE, Boah M. Population-based cross-sectional study of factors influencing full vaccination status of children aged 12- 23 months in a rural district of the Upper East Region, Ghana. BMC Pediatr 2024; 24:168. [PMID: 38459467 PMCID: PMC10921601 DOI: 10.1186/s12887-024-04662-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Achieving universal health coverage includes ensuring that children have access to vaccines that are of high quality, safe, efficacious, and affordable. The Immunisation Agenda 2030 aims to expand services to zero-dose and incompletely vaccinated children and reduce immunisation rate disparities as a contribution to vaccination equity. This study explored the factors influencing full vaccination status among children aged 12 - 23 months in a rural district of the Upper East Region of Ghana. METHODS A population-based cross-sectional study was conducted among carers of children aged 12 -23 months in the Kassena Nankana West district. A multistage sampling technique was used to select 360 carers. Information regarding the vaccination status of children was gathered through a combination of children's health record books and carers' recollections. Information on potential determinants was also systematically collected for analysis in Stata version 15.0. RESULTS The results showed that 76.9% (95% CI: 72.3 - 81.0) of children had full vaccinations per the national schedule. All children received at least one vaccination. A higher percentage of carers with incompletely vaccinated children reported that they had travelled with their children as the primary reason for missing certain vaccine doses. Full vaccination status was significantly associated with secondary (aOR = 2.60; 95% CI: 1.20-5.63) and tertiary (aOR = 3.98, 95% CI: 1.34-11.84) maternal educational level, being in a partnership relationship (aOR = 2.09, 95% CI: 1.03-4.25), and residing in close proximity to healthcare facilities (aOR = 0.41, 95% CI: 0.21-0.80). CONCLUSIONS Our study found that nearly one-quarter of children aged 12-23 months in the study setting are underserved with vaccination services for a variety of reasons. Effectively reaching these children will require strengthening health systems, including eliminating vaccine shortages, addressing the unique challenges faced by unmarried women with children aged 12-23 months, and improving accessibility to vaccination services.
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Affiliation(s)
| | | | - Ruth Nimota Nukpezah
- School of Nursing and Midwifery University for Development Studies, Northern Region, Tamale, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | | | - Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana.
- Center for Population Health, Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda.
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Pagola-Ugarte M, Rakesh A, Gil-Cuesta J, Kidinda D, Kelly TM, Zahaf S, Mahmoud MMOE, Salem MOM, Houmeid M, Cheikh D, Ouldzeidoune N, Bachy C. Improved vaccination coverage after two rounds of multi-antigenic catch-up vaccination in Mauritania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002939. [PMID: 38354187 PMCID: PMC10866457 DOI: 10.1371/journal.pgph.0002939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
Although Mauritania carried out its Expanded Programme on Immunization (EPI), in 2015 the goal of vaccination coverage (VC) remained unmet in Bassikounou district and Mbera camp, contexts with large migrant populations. In response, during 2018, the national authorities, together with Médecins Sans Frontières organised two rounds of multi-antigenic mass vaccination campaigns (2RMASVC). The campaigns included oral polio (OPV), pneumococcal (PCV13), pentavalent and rotavirus vaccines for all eligible children six weeks to 59 months old. This study describes the results of the 2RMASVC. Cross-sectional household VC surveys (VCS1 and VCS2) were conducted before and after the 2RMASVC. Data were collected on vaccination status according to self-reporting and vaccination cards, and on reasons for non-vaccination (RNV). In total, 4,569 children received at least one dose of vaccine in the first round and 5,602 children in the second. Baseline VC, as fully vaccinated, according to VCS1, was 59.9% of children 12 to 59 months in Bassikounou district and 65.8% in Mbera camp. After the 2RMASVC, the coverages increased to 84.7% and 75.9% respectively. Absence from home, lack of motivation, late initiation of vaccinations and lack of awareness about vaccination were the main RNV during the 2RMASVC. Although the 2RMASVC did not reach its goal of 90%-95% VC, the strategy significantly increased VC in the two settings for children aged 12 to 59 months. Therefore, this catch-up approach could be considered to improve VC of children who miss out of the EPI strategy in resource-limited settings.
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Affiliation(s)
- Maider Pagola-Ugarte
- Luxembourg Operational Research Unit (LuxOR), Médecins Sans Frontières Luxembourg, Luxembourg
| | - Ankur Rakesh
- Luxembourg Operational Research Unit (LuxOR), Médecins Sans Frontières Luxembourg, Luxembourg
| | - Julita Gil-Cuesta
- Luxembourg Operational Research Unit (LuxOR), Médecins Sans Frontières Luxembourg, Luxembourg
| | | | | | | | | | | | - Mbareck Houmeid
- Department of Expanded Programme of Immunisation, Ministry of Health, Mauritania
| | | | | | - Catherine Bachy
- Médecins Sans Frontières, Operational Centre of Brussels, Belgium
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4
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Wassenaar M, Fombah AE, Chen H, Owusu-Kyei K, Williams J, Sunders JHC, Llach M, Quinto L, Sesay T, Samai M, Menéndez C, González R. Immunisation coverage and factors associated with incomplete immunisation in children under two during the COVID-19 pandemic in Sierra Leone. BMC Public Health 2024; 24:143. [PMID: 38200476 PMCID: PMC10777622 DOI: 10.1186/s12889-023-17534-2] [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: 10/19/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Routine childhood immunisation is one of the most important life-saving public health interventions. However, many children still have inadequate access to these vaccines and millions remain (partially) unvaccinated globally. As the COVID-19 pandemic disrupted health systems worldwide, its effects on immunisation have become apparent. This study aimed to estimate routine immunisation coverage among children under two in Sierra Leone and to identify factors associated with incomplete immunisation during the COVID-19 pandemic. METHODS A cross-sectional household survey was conducted in three districts in Sierra Leone: Bombali, Tonkolili and Port Loko. A three-stage cluster sampling method was followed to enrol children aged 10-23 months. Information regarding immunisation status was based on vaccination cards or caretaker's recall. Using WHO's definition, a fully immunised child received one BCG dose, three oral polio vaccine doses, three pentavalent vaccine doses and one measles-containing vaccine dose. Following the national schedule, full immunisation status can be achieved at 9 months of age. Data were weighted to reflect the survey's sampling design. Associations between incomplete immunisation and sociodemographic characteristics were assessed through multivariable logistic regression. RESULTS A total of 720 children were enrolled between November and December 2021. Full vaccination coverage was estimated at 65.8% (95% CI 60.3%-71.0%). Coverage estimates were highest for vaccines administered at birth and decreased with doses administered subsequently. Adjusting for age, the lowest estimated coverage was 40.7% (95% CI 34.5%-47.2%) for the second dose of the measles-containing vaccine. Factors found to be associated with incomplete immunisation status were: living in Port Loko district (aOR = 3.47, 95% CI = 2.00-6.06; p-value < 0.001), the interviewed caretaker being Muslim (aOR = 1.94, 95% CI = 1.25-3.02; p-value = 0.015) and the interviewed caretaker being male (aOR = 1.93, 95% CI = 1.03-3.59, p-value = 0.039). CONCLUSION Though full immunisation coverage at district level improved compared with pre-pandemic district estimates from 2019, around one in three surveyed children had missed at least one basic routine vaccination and over half of eligible children had not received the recommended two doses of a measles-containing vaccine. These findings highlight the need to strengthen health systems to improve vaccination uptake in Sierra Leone, and to further explore barriers that may jeopardise equitable access to these life-saving interventions.
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Affiliation(s)
- Myrte Wassenaar
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- University Medical Center Utrecht - Utrecht University, Utrecht, the Netherlands
| | - Augustin E Fombah
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
- Ministry of Health, Freetown, Sierra Leone.
| | - Haily Chen
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Julian Williams
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Joe-Henry C Sunders
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Mireia Llach
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quinto
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Tom Sesay
- Directorate of Reproductive Child Health, Ministry of Health, Freetown, Sierra Leone
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Directorate of Research and Training, Ministry of Health, Freetown, Sierra Leone
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
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Coughlin MM, Smits G, Matson Z, van Binnendijk R, Bankamp B. Multiplex Bead Assay for the Serological Surveillance of Measles and Rubella. Methods Mol Biol 2024; 2808:225-246. [PMID: 38743374 DOI: 10.1007/978-1-0716-3870-5_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
There is increasing interest in evaluating antibody responses to multiple antigen targets in a single assay. Immunity to measles and rubella are often evaluated together because immunity is provided through combined vaccines and because routine immunization efforts and surveillance for measles and rubella pathogens are combined in many countries. The multiplex bead assay (MBA) also known as the multiplex immunoassay (MIA) described here combines the measurement of measles- and rubella-specific IgG antibodies in serum quantitatively according to international serum standards and has been successfully utilized in integrated serological surveillance.
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Affiliation(s)
- Melissa M Coughlin
- Centers for Disease Control and Prevention, National Center for Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, GA, USA.
| | - Gaby Smits
- Center for Immunology and Infectious Diseases and Vaccines, National Institute for Public Health and Environment, Bilthoven, The Netherlands
| | - Zachary Matson
- Centers for Disease Control and Prevention, National Center for Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, GA, USA
| | - Rob van Binnendijk
- Center for Immunology and Infectious Diseases and Vaccines, National Institute for Public Health and Environment, Bilthoven, The Netherlands
| | - Bettina Bankamp
- Centers for Disease Control and Prevention, National Center for Respiratory Diseases, Division of Viral Diseases, Viral Vaccine Preventable Diseases Branch, Atlanta, GA, USA
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Rhoda DA, Cutts FT, Agócs M, Brustrom J, Trimner MK, Clary CB, Clark K, Koffi D, Manibaruta JC, Sowe A, Gunnala R, Ogbuanu IU, Gacic-Dobo M, Danovaro-Holliday MC. A Practical Guide to Pilot Testing Community-Based Vaccination Coverage Surveys. Vaccines (Basel) 2023; 11:1773. [PMID: 38140178 PMCID: PMC10748182 DOI: 10.3390/vaccines11121773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023] Open
Abstract
Pilot testing is crucial when preparing any community-based vaccination coverage survey. In this paper, we use the term pilot test to mean informative work conducted before a survey protocol has been finalized for the purpose of guiding decisions about how the work will be conducted. We summarize findings from seven pilot tests and provide practical guidance for piloting similar studies. We selected these particular pilots because they are excellent models of preliminary efforts that informed the refinement of data collection protocols and instruments. We recommend survey coordinators devote time and budget to identify aspects of the protocol where testing could mitigate project risk and ensure timely assessment yields, credible estimates of vaccination coverage and related indicators. We list specific items that may benefit from pilot work and provide guidance on how to prioritize what to pilot test when resources are limited.
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Affiliation(s)
- Dale A. Rhoda
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Felicity T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mary Agócs
- American Red Cross, 431 18th Street NW, Washington, DC 20006, USA
| | - Jennifer Brustrom
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Mary Kay Trimner
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Caitlin B. Clary
- Biostat Global Consulting, 330 Blandford Drive, Worthington, OH 43085, USA
| | - Kathleen Clark
- American Red Cross, 431 18th Street NW, Washington, DC 20006, USA
| | - David Koffi
- Cabinet d’Appui au Développement Sanitaire, Abidjan, Côte d’Ivoire
| | - Jean Claude Manibaruta
- Burundi Country Office, World Health Organization, Boulevard de I’Uprona-Rohero II, Bujumbura P.O. Box 1450, Burundi
| | - Alieu Sowe
- Ministry of Health and Social Welfare, The Quadrangle, Banjul, The Gambia
| | - Rajni Gunnala
- US Indian Health Services Area Office, Indian Health Service, 40 N Central Ave #600, Phoenix, AZ 85004, USA
| | - Ikechukwu U. Ogbuanu
- Child Health and Mortality Prevention Surveillance (CHAMPS) Network, Crown Agents in Sierra Leone, 28 Bathurst Street, Freetown, Sierra Leone
| | - Marta Gacic-Dobo
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - M. Carolina Danovaro-Holliday
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
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ATEUDJIEU JEROME, TCHIO-NIGHIE KETINAHIRMA, YAKUM MARTINNDINAKIE, GOURA ANDRÉPASCAL, AMADA LAPIA, SONKOUA ISAAC, NKONTCHOU BLAISEWAKAM, KENFACK BRUNO. Innovative approach in assessing the children's immunization status when it cannot be documented. J Public Health Afr 2023; 14:2450. [PMID: 37937064 PMCID: PMC10626340 DOI: 10.4081/jphia.2023.2450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/21/2023] [Indexed: 11/09/2023] Open
Abstract
During surveys, it is recommended that children immunization status should be based on immunization documents. It has been noted that in some communities, a number of children are claimed to be vaccinated but have no evidence of vaccination. This work is proposed to estimate routine immunization coverage in children based on both documented vaccination and the tracking of undocumented immunization. It was a community-based survey targeting children aged 0-59 months in which the immunization status of children was assessed based on vaccination documents and based on a questionnaire tracking immunization sites and period for children with undocumented vaccination. The vaccination coverage and completeness were estimated from data collected in immunization cards and re-estimated after tracking the immunization status of children with no immunization cards. Of 1435 children reached in households, 1430 (99.7%) were included. Of 1072 children aged 12-59 months, 194 (18.1%) received DPT-Hi+Hb 3 with evidence and 399 (37.2%) with evidence and tracking. In the same age group, the dropout rate from DPT-Hi+Hb 1 (157 doses administered) to DPT-Hi+Hb 3 (127 doses administered) with evidence was 19.1% and 42.4% with evidence and tracking. The tracking of immunization status in children with no evidence of vaccination allows to determine their immunization status and to improve the reliability of the estimated vaccination coverage. This strategy could be adopted to be part of the planning and implementation of vaccination coverage surveys of EPI vaccines.
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Affiliation(s)
| | | | - MARTIN NDINAKIE YAKUM
- Department of Health Research, Meilleur Accès aux soins de Santé (M.A. SANTE), Yaoundé
| | - ANDRÉ PASCAL GOURA
- Department of Health Research, Meilleur Accès aux soins de Santé (M.A. SANTE), Yaoundé
| | - LAPIA AMADA
- Department of Health Research, Meilleur Accès aux soins de Santé (M.A. SANTE), Yaoundé
| | - ISAAC SONKOUA
- Department of Health Research, Meilleur Accès aux soins de Santé (M.A. SANTE), Yaoundé
| | - BLAISE WAKAM NKONTCHOU
- Expanded Program of immunization, Ministry of Public Health, Yaounde
- Bill and Melinda Gates Foundation
| | - BRUNO KENFACK
- Department of Gynecology and Obstetrics, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang
- Department of Gynecology and Obstetrics, Dschang District Hospital, Dscang, Cameroon
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8
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Lawal TV, Atoloye KA, Adebowale AS, Fagbamigbe AF. Spatio-temporal analysis of childhood vaccine uptake in Nigeria: a hierarchical Bayesian Zero-inflated Poisson approach. BMC Pediatr 2023; 23:493. [PMID: 37773112 PMCID: PMC10540393 DOI: 10.1186/s12887-023-04300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Globally, child mortality and morbidity remain a serious health challenge and infectious diseases are the leading causes. The use of count models together with spatial analysis of the number of doses of childhood vaccines taken is limited in the literature. We used a Bayesian zero-inflated Poisson regression model with spatio-temporal components to assess the number of doses of childhood vaccines taken among children aged 12-23 months and their associated factors. METHODS Data of 19,564 children from 2003, 2008, 2013 and 2018 population-based cross-sectional Nigeria Demographic and Health Survey were used. The childhood vaccines include one dose of Bacillus-Calmette-Guérin; three doses of Diphtheria-Pertussis-Tetanus; three doses of Polio and one dose of Measles. Uptake of all nine vaccines was regarded as full vaccination. We examined the multilevel factors associated with the number of doses of childhood vaccines taken using descriptive, bivariable and multivariable Bayesian models. Analysis was conducted in Stata version 16 and R statistical packages, and visualization in ArcGIS. RESULTS The prevalence of full vaccination was 6.5% in 2003, 14.8% in 2008, 21.8% in 2013 and 23.3% in 2018. Full vaccination coverage ranged from 1.7% in Sokoto to 51.9% in Anambra. Factors associated with the number of doses of childhood vaccines taken include maternal age (adjusted Incidence "risk" Ratio (aIRR) = 1.05; 95% Credible Interval (CrI) = 1.03-1.07) for 25-34 years and (aIRR = 1.07; 95% CrI = 1.05-1.10) for 35-49 years and education: (aIRR = 1.11, 95% CrI = 1.09-1.14) for primary and (aIRR = 1.16; 95% CrI = 1.13-1.19) for secondary/tertiary education. Other significant factors are wealth status, antenatal care attendance, working status, use of skilled birth attendants, religion, mother's desire for the child, community poverty rate, community illiteracy, and community unemployment. CONCLUSION Although full vaccination has remained low, there have been improvements over the years with wide disparities across the states. Improving the uptake of vaccines by educating women on the benefits of hospital delivery and vaccines through radio jingles and posters should be embraced, and state-specific efforts should be made to address inequality in access to routine vaccination in Nigeria.
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Affiliation(s)
- Temitayo Victor Lawal
- Department of Epidemiology and Medical Statistics, College of Medinec, University of Ibadan, Ibadan, Nigeria
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, FCT Nigeria
| | - Kehinde Adebola Atoloye
- Department of Epidemiology and Medical Statistics, College of Medinec, University of Ibadan, Ibadan, Nigeria
- Viable Knowledge Masters, Abuja, FCT Nigeria
- Viable Helpers Development Organization, Abuja, FCT Nigeria
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, College of Medinec, University of Ibadan, Ibadan, Nigeria
- Population and Health Research Entity, Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, College of Medinec, University of Ibadan, Ibadan, Nigeria
- Division of Population and Behavioural Science, School of Medicine, Health Data Science Unit, University of St Andrews, St Andrews, UK
- Institute of Applied Health Sciences, School of Medicine, Medicinal Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
- Research Methods and Evaluation Unit, Institute for Health & Wellbeing, Coventry University, Coventry, UK
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Wonodi C, Farrenkopf BA. Defining the Zero Dose Child: A Comparative Analysis of Two Approaches and Their Impact on Assessing the Zero Dose Burden and Vulnerability Profiles across 82 Low- and Middle-Income Countries. Vaccines (Basel) 2023; 11:1543. [PMID: 37896946 PMCID: PMC10611163 DOI: 10.3390/vaccines11101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
While there is a coordinated effort around reaching zero dose children and closing existing equity gaps in immunization delivery, it is important that there is agreement and clarity around how 'zero dose status' is defined and what is gained and lost by using different indicators for zero dose status. There are two popular approaches used in research, program design, and advocacy to define zero dose status: one uses a single vaccine to serve as a proxy for zero dose status, while another uses a subset of vaccines to identify children who have missed all routine vaccines. We provide a global analysis utilizing the most recent publicly available DHS and MICS data from 2010 to 2020 to compare the number, proportion, and profile of children aged 12 to 23 months who are 'penta-zero dose' (have not received the pentavalent vaccine), 'truly' zero dose (have not received any dose of BCG, polio, pentavalent, or measles vaccines), and 'misclassified' zero dose children (those who are penta-zero dose but have received at least one other vaccine). Our analysis includes 194,829 observations from 82 low- and middle-income countries. Globally, 14.2% of children are penta-zero dose and 7.5% are truly zero dose, suggesting that 46.5% of penta-zero dose children have had at least one contact with the immunization system. While there are similarities in the profile of children that are penta-zero dose and truly zero dose, there are key differences between the proportion of key characteristics among truly zero dose and misclassified zero dose children, including access to maternal and child health services. By understanding the extent of the connection zero dose children may have with the health and immunization system and contrasting it with how much the use of a more feasible definition of zero dose may underestimate the level of vulnerability in the zero dose population, we provide insights that can help immunization programs design strategies that better target the most disadvantaged populations. If the vulnerability profiles of the truly zero dose children are qualitatively different from that of the penta-zero dose children, then failing to distinguish the truly zero dose populations, and how to optimally reach them, may lead to the development of misguided or inefficient strategies for vaccinating the most disadvantaged population of children.
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10
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Batool R, Qureshi S, Haq Z, Yousafzai MT, Salam RA, Ali R, Sadaf T, Ali M, Qamar FN. Coverage survey of typhoid conjugate vaccine among children aged 6 months to 15 years in an urban slum settlement of Lyari Town Karachi, Pakistan. PLoS One 2023; 18:e0289582. [PMID: 37549155 PMCID: PMC10406246 DOI: 10.1371/journal.pone.0289582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE To estimate the coverage rate of typhoid conjugate vaccine (TCV) among children aged 6 months to 15 years in Lyari Town Karachi, Pakistan. METHODS A cross-sectional survey was conducted to estimate the vaccine coverage of Typbar TCV in Lyari Town Karachi utilizing the World Health Organization (WHO) recommended rapid vaccine coverage assessment technique (30 clusters × 7 households). Sampling was powered at town level and multistage cluster sampling was used. Four union councils were randomly selected from a total of 11 and the survey was conducted in those union councils. After consent was obtained, parents of age-eligible children living in the selected union councils were invited to participate in the survey and information was collected on Typbar TCV vaccination status of children aged 6 months to 15 years. RESULTS Overall, 2325 children were included in the survey. The mean age of the participants was 7.60 ± 3.84 years. The ratio of males to females was equal in the survey sample; 1163 (50.02%) were male. In the total target population, 82% children were found to be vaccinated; however, the vaccination status could be verified for 80%. The vaccine coverage of TCV was comparable among the four union councils and the overall coverage of TCV vaccine in Lyari Town was found to be 80%. The coverage was significantly lower in younger children, 5% and 17% among children aged 6 months to < 2 years and 2 years to < 5 years respectively and 78% among children aged 5 years to 15 years. CONCLUSION The overall immunization coverage rate with TCV was found to be satisfactory. Immunization coverage was comparable among both sexes and the selected union councils but it was relatively low among children in younger age groups.
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Affiliation(s)
- Rabab Batool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
- Center for Child, Adolescent, and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zoya Haq
- Liaqat National Hospital, Karachi, Pakistan
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rehana A. Salam
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rafey Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Tahira Sadaf
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Miqdad Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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11
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Goodman OK, Wagner AL, Riopelle D, Mathew JL, Boulton ML. Vaccination inequities among children 12-23 months in India: An analysis of inter-state differences. Vaccine X 2023; 14:100310. [PMID: 37234595 PMCID: PMC10205789 DOI: 10.1016/j.jvacx.2023.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/15/2023] [Accepted: 04/30/2023] [Indexed: 05/28/2023] Open
Abstract
Background Previous research has shown that socioeconomic and demographic risk factors in children are additive and lead to increasingly negative impacts on vaccination coverage. The goal of this study is to examine if different combinations of four risk factors (infant sex, birth order, maternal education level, and family wealth status) vary by state among children 12-23 months in India and to determine the impact of ≥ 1 risk factor on differences in state vaccination rates. Methods Using data from the National Family Health Survey (NFHS) conducted in India between 2005 and 2006 (NFHS-3) and 2015-2016 (NFHS-4), full vaccination of children 12-23 months was examined. Full vaccination was defined as receipt of one dose of bacillus Calmette-Guérin (BCG), three doses of diphtheria-pertussis-tetanus vaccine (DPT) vaccine, three doses of oral polio vaccine (OPV), and one dose of measles-containing vaccine (MCV). Associations between full vaccination and the four risk factors were assessed using logistic regression. Data were analyzed by the state of residence. Results A total of 60.9% of children 12-23 months were fully vaccinated, in NFHS-4, ranging from 33.9% in Arunachal Pradesh to 91.3% in Punjab. In NFHS-4, the odds of full vaccination across all states were 15% lower among infants with 2 risk factors versus 0 or 1 risk factors (OR: 0.85, 95% CI: 0.80-0.91), and 28% lower among infants with 3 or 4 risk factors versus 0 or 1 risk factor (OR: 0.72, 95% CI: 0.67-0.78). Overall, the absolute difference in the full vaccination coverage in those with > 2 vs < 2 risk factors decreased from -13% in NFHS-3 to -5.6% in NFHS-4, with substantial variation across states. Conclusions Disparities in full vaccination exist among children 12-23 months experiencing > 1 risk factor. Indian states that are more populous or located in the north were more likely to have greater disparities.
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Affiliation(s)
- Octavia K. Goodman
- College of Health Sciences, Old Dominion University, 5115 Terminal Blvd, Norfolk, VA 23529, USA
| | - Abram L. Wagner
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Dakota Riopelle
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | | | - Matthew L. Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Department of Internal Medicine, Infectious Diseases Division, Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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12
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Cunha NSP, de Olinda RA, Fahrat SCL, Barbieri CLA, Braga ALF, Pamplona YDAP, Martins LC. Spatial analysis of vaccine coverage in children under the age of 1 year by mesoregions in Paraíba a northeastern Brazilian state. PLoS One 2023; 18:e0288651. [PMID: 37463166 DOI: 10.1371/journal.pone.0288651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023] Open
Abstract
Immunization is one of the most effective measures in public health, and it is responsible for the reduction of vaccine-preventable diseases. In the present study, vaccine coverage (VC) and the spatial dynamics of homogeneity of VC (HVC) were compared and analyzed in the terms of the immunobiologicals administered to children aged < 1 year in a state in Paraíba, Brazil. This is a mixed ecological study that used public-domain secondary data from the years 2016 and 2017 from the Information System of the Brazilian National Immunization Program (SI-PNI) and the Brazilian National Information System of Live Births (SINASC). VC rates were calculated by dividing the number of administered doses by the number of live births. Then, VC was classified into four categories. The Municipal HVC was considered adequate when the overall VC exceeds 75%. The study included a descriptive analysis and a spatial autocorrelation analysis for HVC using global and local Moran's statistics. The stratified VC analysis revealed a significant number of municipalities in each of the state's mesoregions with low or very low VC rates for all immunobiologicals, with the Mata Paraibana mesoregion having the worst percentages in both years studied. The spatial analysis of HVC revealed several clusters of inadequate homogeneity, with Mata Paraibana being the worst mesoregion in 2016. The analysis of spatial dynamics and spatial statistics techniques allows the precise identification of vulnerable areas, "vaccination pockets," making it possible to develop plans aimed at meeting the targets of the PNI.
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Affiliation(s)
- Nairmara Soares Pimentel Cunha
- Vaccine Observatory, Stricto Sensu Graduate Program in Collective Health of the Catholic University of Santos, Santos, São Paulo, Brazil
- Children's Institute, University Clinics Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Sylvia Costa Lima Fahrat
- Children's Institute, University Clinics Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Carolina Luisa Alves Barbieri
- Vaccine Observatory, Stricto Sensu Graduate Program in Collective Health of the Catholic University of Santos, Santos, São Paulo, Brazil
| | - Alfésio Luís Ferreira Braga
- Environmental Exposure and Risk Assessment Group, Stricto Sensu Graduate Program in Collective Health of the Catholic University of Santos, Santos, São Paulo, Brazil
| | - Ysabely de Aguiar Pontes Pamplona
- Vaccine Observatory, Stricto Sensu Graduate Program in Collective Health of the Catholic University of Santos, Santos, São Paulo, Brazil
- Environmental Exposure and Risk Assessment Group, Stricto Sensu Graduate Program in Collective Health of the Catholic University of Santos, Santos, São Paulo, Brazil
| | - Lourdes Conceição Martins
- Vaccine Observatory, Stricto Sensu Graduate Program in Collective Health of the Catholic University of Santos, Santos, São Paulo, Brazil
- Environmental Exposure and Risk Assessment Group, Stricto Sensu Graduate Program in Collective Health of the Catholic University of Santos, Santos, São Paulo, Brazil
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13
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Sbarra AN, Rolfe S, Haeuser E, Nguyen JQ, Adamu A, Adeyinka D, Ajumobi O, Akunna C, Amusa G, Dahiru T, Ekholuenetale M, Esezobor C, Fowobaje K, Hay SI, Ibeneme C, Ibitoye SE, Ilesanmi O, Kayode G, Krohn K, Lim SS, Medeiros LE, Mohammed S, Nwatah V, Okoro A, Olagunju AT, Olusanya BO, Osarenotor O, Owolabi M, Pickering B, Sufiyan MB, Uzochukwu B, Walker A, Mosser JF. Estimating vaccine coverage in conflict settings using geospatial methods: a case study in Borno state, Nigeria. Sci Rep 2023; 13:11085. [PMID: 37422502 PMCID: PMC10329660 DOI: 10.1038/s41598-023-37947-8] [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: 05/13/2022] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Abstract
Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first- and third-dose diphtheria-tetanus-pertussis vaccine coverage in Borno state, Nigeria, using a spatiotemporal MBG modelling approach, then compared these to estimates from recent conflict-affected, household-based surveys. We compared sampling cluster locations from recent household-based surveys to geolocated data on conflict locations and modelled spatial coverage estimates, while also investigating the importance of reliable population estimates when assessing coverage in conflict settings. These results demonstrate that geospatially-modelled coverage estimates can be a valuable additional tool to understand coverage in locations where conflict prevents representative sampling.
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Affiliation(s)
- Alyssa N Sbarra
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA.
| | - Sam Rolfe
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Emily Haeuser
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Jason Q Nguyen
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Aishatu Adamu
- Community Medicine Department, Bayero University Kano, Kano, Nigeria
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Olufemi Ajumobi
- School of Public Health, University of Nevada Reno, Reno, USA
- National Malaria Elimination Program, Federal Ministry of Health, Abuja, Nigeria
| | - Chisom Akunna
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
- Department of Public Health, The Intercountry Centre for Oral Health (ICOH) for Africa, Jos, Nigeria
| | - Ganiyu Amusa
- Department of Medicine, University of Jos, Jos, Nigeria
- Department of Internal Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Tukur Dahiru
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Christopher Esezobor
- Department of Paediatrics, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Kayode Fowobaje
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Child Survival Unit, Centre for African Newborn Health and Nutrition, Ibadan, Nigeria
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Charles Ibeneme
- Department of Public Health and Disease Control, Abia State Ministry of Health, Umuahia, Nigeria
- Nigerian Field Epidemiology and Laboratory Training Program, African Field Epidemiology Network, Abuja, Nigeria
| | | | - Olayinka Ilesanmi
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Gbenga Kayode
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Kris Krohn
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Lyla E Medeiros
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Shafiu Mohammed
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Vincent Nwatah
- Department of Pediatrics, National Hospital Abuja, Abuja, Nigeria
- Department of International Public Health, University of Liverpool, Liverpool, UK
| | | | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | | | - Osayomwanbo Osarenotor
- Department of Environmental Management and Toxicology, University of Benin, Benin City, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Brandon Pickering
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | | | - Benjamin Uzochukwu
- Department of Community Medicine, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Ally Walker
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Jonathan F Mosser
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA.
- Department of Health Metrics Sciences, University of Washington, Seattle, USA.
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14
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Nogareda F, Gharpure R, Contreras M, Velandia M, Lucia Pacis C, Elena Chevez A, Azziz-Baumgartner E, Salas D. Seasonal influenza vaccination in the Americas: Progress and challenges during the COVID-19 pandemic. Vaccine 2023:S0264-410X(23)00689-8. [PMID: 37328348 PMCID: PMC10247885 DOI: 10.1016/j.vaccine.2023.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Vaccination is one of the most effective measures to prevent influenza illness and its complications; influenza vaccination remained important during the COVID-19 pandemic to prevent additional burden on health systems strained by COVID-19 demand. OBJECTIVES We describe policies, coverage, and progress of seasonal influenza vaccination programs in the Americas during 2019-2021 and discuss challenges in monitoring and maintaining influenza vaccination coverage among target groups during the COVID-19 pandemic. METHODS We used data on influenza vaccination policies and vaccination coverage reported by countries/territories via the electronic Joint Reporting Form on Immunization (eJRF) for 2019-2021. We also summarized country vaccination strategies shared with PAHO. RESULTS As of 2021, 39 (89 %) out of 44 reporting countries/territories in the Americas had policies for seasonal influenza vaccination. Countries/territories adapted health services and immunization delivery strategies using innovative approaches, such as new vaccination sites and expanded schedules, to ensure continuation of influenza vaccination during the COVID-19 pandemic. However, among countries/territories that reported data to eJRF in both 2019 and 2021, median coverage decreased; the percentage point decrease was 21 % (IQR = 0-38 %; n = 13) for healthcare workers, 10 % (IQR = -1.5-38 %; n = 12) for older adults, 21 % (IQR = 5-31 %; n = 13) for pregnant women, 13 % (IQR = 4.8-20.8 %; n = 8) for persons with chronic diseases, and 9 % (IQR = 3-27 %; n = 15) for children. CONCLUSIONS Countries/territories in the Americas successfully adapted influenza vaccination delivery to continue vaccination services during the COVID-19 pandemic; however, reported influenza vaccination coverage decreased from 2019 to 2021. Reversing declines in vaccination will necessitate strategic approaches that prioritize sustainable vaccination programs across the life course. Efforts should be made to improve the completeness and quality of administrative coverage data. Lessons learned from COVID-19 vaccination, such as the rapid development of electronic vaccination registries and digital certificates, might facilitate advances in coverage estimation.
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Affiliation(s)
- Francisco Nogareda
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA.
| | - Radhika Gharpure
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcela Contreras
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| | - Martha Velandia
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| | - Carmelita Lucia Pacis
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
| | - Ana Elena Chevez
- Pan American Health Organization, Revolving Fund, Washington, DC, USA
| | | | - Daniel Salas
- Pan American Health Organization, Special Program Comprehensive Immunization, Washington, DC, USA
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15
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Kundu S, Kundu S, Seidu AA, Okyere J, Ghosh S, Hossain A, Alshahrani NZ, Banna MHA, Rahman MA, Ahinkorah BO. Factors influencing and changes in childhood vaccination coverage over time in Bangladesh: a multilevel mixed-effects analysis. BMC Public Health 2023; 23:862. [PMID: 37170088 PMCID: PMC10173930 DOI: 10.1186/s12889-023-15711-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the associated factors and changes in childhood vaccination coverage over time in Bangladesh. METHODS Bangladesh's Demographic and Health Surveys from 2011, 2014, and 2017-18 provided data for this study on vaccination coverage among children aged 12 to 35 months. For three survey periods, multilevel binary logistic regression models were employed. RESULTS The overall prevalence (weighted) of full vaccination among children aged 12-35 months were 86.17% in 2011, 85.13% in 2014, and 89.23% in 2017-18. Children from families with high wealth index, mothers with higher education, and over the age of 24 and who sought at least four ANC visits, as well as children from urban areas were more likely to receive full vaccination. Rangpur division had the highest change rate of vaccination coverage from 2011 to 2014 (2.26%), whereas Sylhet division had the highest change rate from 2014 to 2017-18 (34.34%). CONCLUSION To improve immunization coverage for Bangladeshi children, policymakers must integrate vaccine programs, paying special attention to mothers without at least a high school education and families with low wealth index. Increased antenatal care visits may also aid in increasing the immunization coverage of their children.
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Affiliation(s)
- Satyajit Kundu
- Global Health Institute, North South University, Dhaka, 1229, Bangladesh.
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh.
| | - Subarna Kundu
- Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Abdul-Aziz Seidu
- Faculty of Built and Natural Environment, Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Susmita Ghosh
- Department of Food Technology and Nutrition Science, Noakhali Science and Technology University, Noakhali, Bangladesh
- Department of Nutrition Science, Purdue University, West Lafayette, IN, 47907, USA
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Najim Z Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, 21589, Saudi Arabia
| | - Md Hasan Al Banna
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
- Nutrition Initiative (NI), Kushtia, Bangladesh
| | - Md Ashfikur Rahman
- Development Studies Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Koyuncu A, Ishizumi A, Daniels D, Jalloh MF, Wallace AS, Prybylski D. The Use of Adaptive Sampling to Reach Disadvantaged Populations for Immunization Programs and Assessments: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11020424. [PMID: 36851301 PMCID: PMC9961530 DOI: 10.3390/vaccines11020424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
Vaccines prevent 4-5 million deaths every year, but inequities in vaccine coverage persist among key disadvantaged subpopulations. Under-immunized subpopulations (e.g., migrants, slum residents) may be consistently missed with conventional methods for estimating immunization coverage and assessing vaccination barriers. Adaptive sampling, such as respondent-driven sampling, may offer useful strategies for identifying and collecting data from these subpopulations that are often "hidden" or hard-to-reach. However, use of these adaptive sampling approaches in the field of global immunization has not been systematically documented. We searched PubMed, Scopus, and Embase databases to identify eligible studies published through November 2020 that used an adaptive sampling method to collect immunization-related data. From the eligible studies, we extracted relevant data on their objectives, setting and target population, and sampling methods. We categorized sampling methods and assessed their frequencies. Twenty-three studies met the inclusion criteria out of the 3069 articles screened for eligibility. Peer-driven sampling was the most frequently used adaptive sampling method (57%), followed by geospatial sampling (30%), venue-based sampling (17%), ethnographic mapping (9%), and compact segment sampling (9%). Sixty-one percent of studies were conducted in upper-middle-income or high-income countries. Data on immunization uptake were collected in 65% of studies, and data on knowledge and attitudes about immunizations were collected in 57% of studies. We found limited use of adaptive sampling methods in measuring immunization coverage and understanding determinants of vaccination uptake. The current under-utilization of adaptive sampling approaches leaves much room for improvement in how immunization programs calibrate their strategies to reach "hidden" subpopulations.
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Affiliation(s)
- Aybüke Koyuncu
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Atsuyoshi Ishizumi
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Danni Daniels
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Mohamed F Jalloh
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Aaron S Wallace
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
| | - Dimitri Prybylski
- Global Immunization Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30329, USA
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17
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Bender RG, Shen J, Aravkin A, Bita Fouda AA, Bwaka AM, Galles NC, Haeuser E, Hay SI, Latt A, Mwenda JM, Rogowski EL, Sbarra AN, Sorensen RJ, Vongpradith A, Wright C, Zheng P, Mosser JF, Kyu HH. Meningococcal A conjugate vaccine coverage in the meningitis belt of Africa from 2010 to 2021: a modelling study. EClinicalMedicine 2023; 56:101797. [PMID: 36880052 PMCID: PMC9985031 DOI: 10.1016/j.eclinm.2022.101797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND As of the end of 2021, twenty-four countries in the African meningitis belt have rolled out mass campaigns of MenAfriVac®, a meningococcal A conjugate vaccine (MACV) first introduced in 2010. Twelve have completed introduction of MACV into routine immunisation (RI) schedules. Although select post-campaign coverage data are published, no study currently comprehensively estimates MACV coverage from both routine and campaign sources in the meningitis belt across age, country, and time. METHODS In this modelling study, we assembled campaign data from the twenty-four countries that had introduced any immunisation activity during or before the year 2021 (Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d'Ivoire, Democratic Republic of the Congo, Ethiopia, Eritrea, the Gambia, Ghana, Guinea, Guinea Bissau, Kenya, Mali, Mauritania, Niger, Nigeria, Senegal, South Sudan, Sudan, Togo and Uganda) via WHO reports and RI data via systematic review. Next, we modelled RI coverage using Spatiotemporal Gaussian Process Regression. Then, we synthesized these estimates with campaign data into a cohort model, tracking coverage for each age cohort from age 1 to 29 years over time for each country. FINDINGS Coverage in high-risk locations amongst children aged 1-4 in 2021 was estimated to be highest in Togo with 96.0% (95% uncertainty interval [UI] 92.0-99.0), followed by Niger with 87.2% (95% UI 85.3-89.0) and Burkina Faso, with 86.4% (95% UI 85.1-87.6). These countries had high coverage values driven by an initial successful mass immunisation campaign, followed by a catch-up campaign, followed by introduction of RI. Due to the influence of older mass vaccination campaigns, coverage proportions skewed higher in the 1-29 age group than the 1-4 group, with a median coverage of 82.9% in 2021 in the broader age group compared to 45.6% in the narrower age group. INTERPRETATION These estimates highlight where gaps in immunisation remain and emphasise the need for broader efforts to strengthen RI systems. This methodological framework can be applied to estimate coverage for any vaccine that has been delivered in both routine and supplemental immunisation activities. FUNDING Bill and Melinda Gates Foundation.
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Affiliation(s)
- Rose G. Bender
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jasmine Shen
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Aleksandr Aravkin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
| | | | - Ado M. Bwaka
- World Health Organization Regional Office for Africa, Inter-Country Support Team, Ouagadougou, Burkina Faso
| | - Natalie C. Galles
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Emily Haeuser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Anderson Latt
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response Cluster, Dakar Emergency Hub, Dakar, Senegal
| | - Jason M. Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | - Emma L.B. Rogowski
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alyssa N. Sbarra
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Reed J.D. Sorensen
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Avina Vongpradith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Peng Zheng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Jonathan F. Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- Corresponding author. Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA 98105, USA.
| | - Hmwe H. Kyu
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
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18
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Gutierrez JP, Johri M. Socioeconomic and geographic inequities in vaccination among children 12 to 59 months in Mexico, 2012 to 2021. Rev Panam Salud Publica 2023; 47:e35. [PMID: 36751676 PMCID: PMC9899057 DOI: 10.26633/rpsp.2023.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/29/2022] [Indexed: 02/07/2023] Open
Abstract
Objective To document the evolution of socioeconomic and geographical inequalities in childhood vaccination in Mexico from 2012 to 2021. Methods Repeated cross-sectional analysis using three rounds of National Health and Nutrition Surveys (2012, 2018, and 2021). Dichotomous variables were created to identify the proportion of children who received no dose of each vaccine included in the national immunization schedule (BCG; diphtheria, pertussis, and tetanus-containing; rotavirus; pneumococcal conjugate; and measles, mumps, and rubella [MMR]), and the proportion completely unvaccinated. The distribution of unvaccinated children was analyzed by state, and by socioeconomic status using the concentration index. Results The prevalence of completely unvaccinated children in Mexico was low, with 0.3% children in 2012 and 0.8% children in 2021 receiving no vaccines (p = 0.070). Notwithstanding, for each vaccine, an important proportion of children missed receiving any dose. Notably, the prevalence of MMR unvaccinated children was 10.2% (95% CI 9.2-11.1) in 2012, 22.3% (95% CI 20.9-23.8) in 2018, and 29.1% (95% CI 26.3-31.8) in 2021 (p < 0.001 for the difference between 2012 and 2021). The concentration index indicated pro-rich inequalities in non-vaccination for 2 of 5 vaccines in 2012, 3 of 5 vaccines in 2018, and 4 of 5 vaccines in 2021. There were marked subnational variations. The percentage of MMR unvaccinated children ranged from 3.3% to 17.9% in 2012, 5.5% to 36.5% in 2018, and 13.1% to 72.5% in 2021 across the 32 states of Mexico. Conclusions Equitable access to basic childhood vaccines in Mexico has deteriorated over the past decade. Vigilant equity monitoring coupled with tailored strategies to reach those left out is urgently required.
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Affiliation(s)
- Juan Pablo Gutierrez
- National Autonomous University of MexicoMexico CityMexicoNational Autonomous University of Mexico, Mexico City, Mexico,
| | - Mira Johri
- Université de MontréalMontreal, QuebecCanadaUniversité de Montréal, Montreal, Quebec, Canada
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19
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Sulistyawati S, Wibowo TA, Rokhmayanti R, Nugroho ASD, Sukesi TW, Hastuti SKW, Mulasari SA, Feletto M. Introduction and implementation of an immunization information system in the Indonesian province of Daerah Istimewa Yogyakarta: lessons for scaling-up. BMC Health Serv Res 2023; 23:12. [PMID: 36604659 PMCID: PMC9815049 DOI: 10.1186/s12913-022-08910-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Immunization is critical to saving children from infections. To increase vaccination coverage, valid and real-time data are needed. Accordingly, it is essential to have a good report system that serves as defaulter tracking to prevent children's immunization failure. The Daerah Istimewa Yogyakarta (DIY) Health Office introduced an electronic immunization registry and successfully implemented it for more than five years. It is the only individual-based record system in Indonesia that has been sustainably operated for a long time. Yet, no systematic assessment of this system has been conducted to date. This study examines the Sistem Informasi Imunisasi Terpadu (SIMUNDU) introduction and implementation process with a view to extracting lessons that could inform scalability and sustainability across the country. METHODS This study used an explanatory sequential mixed-method design, which collected quantitative data from 142 participants and qualitative data from nine participants. The data entry clerk at a health facility was systematically selected to participate in the survey, while in the key informant interview, the informant was selected based on the survey result. A descriptive and thematic approach was adopted to analyze the quantitative and qualitative data. Results from across the two approaches were integrated for comparison and contrast. RESULTS Findings are presented according to three core themes that emerged from the data: system strengths, potential threats, weakness and opportunities for scaling-up. Strengths, i.e., factors contributing to the success of SIMUNDU, include management, system performance, people's behavior, and resources. Potential threats to sustaining the system include individual capacity, technical or system issues, and high workload. Opportunities - i.e., a promising factor that influences the SIMUNDU ability to operate sustainably - such as continuity, expectation, and the possibility of scaling up. CONCLUSIONS SIMUNDU is a promising innovation for Indonesia, beyond DIY. There is agreement about the potential for scaling up this IIS to other provinces. The experience of implementing this system in DIY over the past five years has shown that the benefits outweigh the challenges, and SIMUNDU has grown into a robust yet user-friendly system.
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Affiliation(s)
- Sulistyawati Sulistyawati
- Faculty of Public Health, Universitas Ahmad Dahlan, Kampus 3 - Jl. Prof Dr Soepomo, Janturan, Umbulharjo, Yogyakarta, Indonesia.
| | | | - Rokhmayanti Rokhmayanti
- grid.444626.60000 0000 9226 1101Faculty of Public Health, Universitas Ahmad Dahlan, Kampus 3 - Jl. Prof Dr Soepomo, Janturan, Umbulharjo, Yogyakarta, Indonesia
| | | | - Tri Wahyuni Sukesi
- grid.444626.60000 0000 9226 1101Faculty of Public Health, Universitas Ahmad Dahlan, Kampus 3 - Jl. Prof Dr Soepomo, Janturan, Umbulharjo, Yogyakarta, Indonesia
| | - Siti Kurnia Widi Hastuti
- grid.444626.60000 0000 9226 1101Faculty of Public Health, Universitas Ahmad Dahlan, Kampus 3 - Jl. Prof Dr Soepomo, Janturan, Umbulharjo, Yogyakarta, Indonesia
| | - Surahma Asti Mulasari
- grid.444626.60000 0000 9226 1101Faculty of Public Health, Universitas Ahmad Dahlan, Kampus 3 - Jl. Prof Dr Soepomo, Janturan, Umbulharjo, Yogyakarta, Indonesia
| | - Marta Feletto
- grid.458360.c0000 0004 0574 1465Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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20
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Winter AK, Takahashi S, Carcelen AC, Hayford K, Mutale W, Mwansa FD, Sinyange N, Ngula D, Moss WJ, Mutembo S. An evaluation of the early impact of the COVID-19 pandemic on Zambia's routine immunization program. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000554. [PMID: 37130089 PMCID: PMC10153718 DOI: 10.1371/journal.pgph.0000554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
Implications of the COVID-19 pandemic for both populations and healthcare systems are vast. In addition to morbidity and mortality from COVID-19, the pandemic also disrupted local health systems, including reductions or delays in routine vaccination services and catch-up vaccination campaigns. These disruptions could lead to outbreaks of other infectious diseases that result in an additional burden of disease and strain on the healthcare system. We evaluated the impact of the COVID-19 pandemic on Zambia's routine childhood immunization program in 2020 using multiple sources of data. We relied on administrative vaccination data and Zambia's 2018 Demographic and Health Survey to project national disruptions to district-specific routine childhood vaccination coverage within the pandemic year 2020. Next, we leveraged a 2016 population-based serological survey to predict age-specific measles seroprevalence and assessed the impact of changes in vaccination coverage on measles outbreak risk in each district. We found minor disruptions to routine administration of measles-rubella and pentavalent vaccines in 2020. This was in part due to Zambia's Child Health Week held in June of 2020 which helped to reach children missed during the first six months of the year. We estimated that the two-month delay in a measles-rubella vaccination campaign, originally planned for September of 2020 but conducted in November of 2020 as a result of the pandemic, had little impact on modeled district-specific measles outbreak risks. This study estimated minimal increases in the number of children missed by vaccination services in Zambia during 2020. However, the ongoing SARS-CoV-2 transmission since our analysis concluded means efforts to maintain routine immunization services and minimize the risk of measles outbreaks will continue to be critical. The methodological framework developed in this analysis relied on routinely collected data to estimate disruptions of the COVID-19 pandemic to national routine vaccination program performance and its impact on children missed at the subnational level can be deployed in other countries or for other vaccines.
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Affiliation(s)
- Amy K Winter
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, United States of America
| | - Saki Takahashi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrea C Carcelen
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kyla Hayford
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wilbroad Mutale
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Francis D Mwansa
- Child Health Unit, Directorate of Public Health and Research, Ministry of Health, Lusaka, Zambia
| | - Nyambe Sinyange
- Field Epidemiology Training Program, Zambia National Public Health Institute, Lusaka, Zambia
| | - David Ngula
- Child Health Unit, Directorate of Public Health and Research, Ministry of Health, Lusaka, Zambia
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Simon Mutembo
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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21
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Aslam F, Babar ZUD, Madni A, Asghar M, Yue Y. Unveiling and addressing implementation barriers of vaccination communication strategy: Perspectives from government officials at national and provincial levels. Hum Vaccin Immunother 2022; 18:2153513. [PMID: 36494089 PMCID: PMC9766463 DOI: 10.1080/21645515.2022.2153513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Communication strategy is one of the support of primary health care (PHC) that can address demand-side barriers and socio-cultural factors to promote better services. Conversely, communication strategies have not been a distinct emphasis of vaccination research in the country until now. Therefore, this study aimed to find the elements that influence the provision of vaccination communication in Pakistan. Twenty-two semi-structured interviews with key stakeholders in vaccine communication were conducted using qualitative methodologies (Jan 2022-March 2022). The interviews revolved around factors affecting the implementation of communication. Interviews were transcribed and analyzed using thematic analysis. By using the SURE framework, numerous factors that affect vaccination communication were identified under three major themes such as organizational-level, constitutional, and community-level factors. Five subthemes marked the organizational-level factors such as constrained budget, infrastructure deficits, inconsistent comprehensive strategy, health workforce, and inadequate training. Two subthemes are derived regarding constitutional and community-level factors, respectively, such as governance and leadership, health communication interventions not a policymaker's priority, community perceptions and practices, and formal partnership lacking between national and local stakeholders. Additionally, employment of established communication committees, improved money allocation, engagement of traditional and religious institutions, and political backing were identified as solutions for improvement. Communication activities are an important part of immunization programs in order to increase vaccination coverage. To be able to execute communication interventions more successfully, national and provincial stakeholders must work together to identify the elements that affect vaccine provision. Additional rigorous implementation studies could aid in the development of clearer knowledge of the system-wide constraints obstructing the program's efficiency.
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Affiliation(s)
- Fahmida Aslam
- International Food and Drug Policy and Law Research Center, School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | | | - Asadullah Madni
- Department of Pharmaceutics, Faculty of Pharmacy, The Islamia University of Bhawalpur, Bhawalpur, Pakistan
| | - Muhammad Asghar
- Cardiac & Medical Department, Sialkot Medical Complex, Siaklot, Pakistan
| | - Yang Yue
- International Food and Drug Policy and Law Research Center, School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China,School of Pharmaceutical Sciences, Tsinghua University, Beijing, China,Institute of Pharmaceutical Regulatory Sciences, Tsinghua University, Beijing, China,Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China,CONTACT Yang Yue International Food and Drug Policy and Law Research Center, School of Business Administration, Shenyang Pharmaceutical University, Shenyang110000, China
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22
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Utazi CE, Aheto JMK, Chan HMT, Tatem AJ, Sahu SK. Conditional probability and ratio-based approaches for mapping the coverage of multi-dose vaccines. Stat Med 2022; 41:5662-5678. [PMID: 36129171 PMCID: PMC9826002 DOI: 10.1002/sim.9586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/10/2022] [Accepted: 09/09/2022] [Indexed: 01/11/2023]
Abstract
Many vaccines are often administered in multiple doses to boost their effectiveness. In the case of childhood vaccines, the coverage maps of the doses and the differences between these often constitute an evidence base to guide investments in improving access to vaccination services and health system performance in low and middle-income countries. A major problem often encountered when mapping the coverage of multi-dose vaccines is the need to ensure that the coverage maps decrease monotonically with successive doses. That is, for doses i $$ i $$ and j $$ j $$ , i < j ⇒ p i ( s ) ≥ p j ( s ) $$ i<j\Rightarrow {p}_i\left(\boldsymbol{s}\right)\ge {p}_j\left(\boldsymbol{s}\right) $$ , where p i ( s ) $$ {p}_i\left(\boldsymbol{s}\right) $$ is the coverage of dose i $$ i $$ at spatial location s $$ \boldsymbol{s} $$ . Here, we explore conditional probability (CP) and ratio-based (RB) approaches for mapping p i ( s ) $$ {p}_i\left(\boldsymbol{s}\right) $$ , embedded within a binomial geostatistical modeling framework, to address this problem. The fully Bayesian model is implemented using the INLA and SPDE approaches. Using a simulation study, we find that both approaches perform comparably for out-of-sample estimation under varying point-level sample size distributions. We apply the methodology to map the coverage of the three doses of diphtheria-tetanus-pertussis vaccine using data from the 2018 Nigeria Demographic and Health Survey. The coverage maps produced using both approaches are almost indistinguishable, although the CP approach yielded more precise estimates on average in this application. We also provide estimates of zero-dose children and the dropout rates between the doses. The methodology is straightforward to implement and can be applied to other vaccines and geographical contexts.
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Affiliation(s)
- Chigozie Edson Utazi
- WorldPop, School of Geography and Environmental ScienceUniversity of SouthamptonSouthamptonUK,School of Mathematical SciencesUniversity of SouthamptonSouthamptonUK
| | - Justice Moses K. Aheto
- WorldPop, School of Geography and Environmental ScienceUniversity of SouthamptonSouthamptonUK
| | - Ho Man Theophilus Chan
- WorldPop, School of Geography and Environmental ScienceUniversity of SouthamptonSouthamptonUK,School of Mathematical SciencesUniversity of SouthamptonSouthamptonUK
| | - Andrew J. Tatem
- WorldPop, School of Geography and Environmental ScienceUniversity of SouthamptonSouthamptonUK
| | - Sujit K. Sahu
- School of Mathematical SciencesUniversity of SouthamptonSouthamptonUK
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23
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Abstract
IMPORTANCE Measuring vaccination coverage rates and equity is crucial for informing immunization policies in China. OBJECTIVES To estimate coverage rates and multidimensional equity for childhood vaccination in China. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted via a survey in 10 Chinese provinces between August 5 and October 16, 2019, among children ages 6 months to 5 years and their primary caregivers. Children's vaccination records and their primary caregivers' demographics and socioeconomic status were collected. Data were analyzed from November 2019 to March 2022. MAIN OUTCOMES AND MEASURES Vaccine coverage rates were measured as a percentage of National Immunization Program (NIP) and non-NIP vaccines administered before the day on which the child was surveyed. A multidimensional equity model applied a standardized approach to ranking individuals from least to most unfairly disadvantaged by estimating differences between observed vaccination status and estimated vaccination status as function of fair and unfair variation. Fair sources of variation in coverage included whether the child was of age to receive the vaccine, and unfair sources of variation included sex of the child and sociodemographic characteristics of caregivers. Absolute equity gaps (AEGs), concentration index values, and decompositions of factors associated with vaccine equity were estimated in the model. RESULTS Vaccine records and sociodemographic information of 5294 children (2976 [52.8%] boys and 2498 [47.2%] girls; age range, 6-59 months; 1547 children aged 12-23 months) and their primary caregivers were collected from 10 provinces. Fully immunized coverage under the NIP was 83.1% (95% CI, 82.0%-84.1%) at the national level and more than 80% in 7 provinces (province coverage ranged from 77.8% [95% CI, 74.3% to 81.3%] in Jiangxi to 88.4% [95% CI, 85.7%-91.1%] in Beijing). For most non-NIP vaccines, however, coverage rates were less than 50%, ranging from 1.8% (95% CI, 1.3%-2.2%) for the third dose of rotavirus vaccine to 67.1% (65.4% to 68.8%) for the first dose of the varicella vaccine. The first dose of Haemophilus influenzae type b vaccine had the largest AEG, at 0.603 (95% CI, 0.570-0.636), and rotavirus vaccine dose 3 had the largest concentration index value, at 0.769 (95% CI, 0.709-0.829). The largest share of non-NIP vaccine inequity was contributed by monthly family income per capita, followed by education level, place of residence, and province for caregivers. For example, the proportion of explained inequity for pneumococcal conjugate vaccine dose 3 was 40.94% (95% CI, 39.49%-42.39%), 22.67% (95% CI, 21.43%-23.9%), 27.15% (95% CI, 25.84%-28.46%), and 0.68% (95% CI, 0.44%-0.92%) for these factors, respectively. CONCLUSIONS AND RELEVANCE This cross-sectional study found that NIP vaccination coverage in China was high but there was inequity for non-NIP vaccines. These findings suggest that improvements in equitable coverage of non-NIP vaccination may be urgently needed to meet national immunization goals.
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Affiliation(s)
- Haijun Zhang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaozhen Lai
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Joshua Mak
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Salin Sriudomporn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Haonan Zhang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
- Peking University Health Science Center, Chinese Center for Disease Control and Prevention Joint Research Center for Vaccine Economics, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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24
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Balgovind P, Mohammadnezhad M. Perceptions of Healthcare Workers (HCWs) towards childhood immunization and immunization services in Fiji: a qualitative study. BMC Pediatr 2022; 22:610. [PMID: 36271395 PMCID: PMC9585826 DOI: 10.1186/s12887-022-03665-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Childhood immunization has been globally recognized as the single most effective strategy in preventing childhood diseases and mortality. The perceptions of healthcare workers are important as their behavior and attitudes influence parental decision–making process. This research aimed to explore the factors that influence healthcare workers’ experience and perceptions about delivering childhood immunization in Fiji. Materials and methods A qualitative study was conducted in three randomly selected health centers in Suva, Fiji from March 1st to April 5th, 2021. Five focus group discussions were conducted with healthcare workers who were chosen purposively, had worked in the health center for at least 6 months and included either gender. Those that did not consent or did not meet the inclusion criteria were excluded. The interviews were guided by semi–structured open–ended questionnaire and were recorded into a digital voice recorder. The data were coded, sorted, and then categorized into themes, and transcribed onto Microsoft Word. Thematic analysis was utilized to sort the key phrases from the recorded interviews. Results There were a total of 22 participants for the focus group discussions, with their ages ranging from 25 to 51 years, included 3 medical officers, 1 nurse practitioner and 18 registered nurses. Three major themes emerged, which included: healthcare worker factors, parental factors and health system factors. Subthemes identified from the healthcare worker factors were worker knowledge and attitudes. The subtheme for parental factors that emerged were defaulters, parental attitudes, perceived behavior and religious beliefs. For health system factors the subthemes were service delivery, registration, infrastructure, staff turnover, staff training and changes to the immunization schedule. Conclusion Some of the perceived barriers reported by the healthcare workers were parental religious beliefs, parental knowledge and attitude, social or physical factors (finances, transportation, childcare and work conflicts), access to health services, immunization services and policies, hours of operation, waiting time and missed opportunities. Health workers acknowledged that they have an important role to play in immunization as they are the source of information and motivation for parents. Further studies are needed to be conducted nationally to determine the perceptions of healthcare workers towards immunization and how the services can be improved on a national level. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03665-9.
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Affiliation(s)
- Preeti Balgovind
- Ministry of Health and Medical Services, Suva, Fiji Islands., National University, Suva, Fiji Islands.,School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom
| | - Masoud Mohammadnezhad
- Ministry of Health and Medical Services, Suva, Fiji Islands., National University, Suva, Fiji Islands. .,School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom.
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25
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Valdecantos RL, Palladino R, Lo Vecchio A, Montella E, Triassi M, Nardone A. Organisational and Structural Drivers of Childhood Immunisation in the European Region: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10091390. [PMID: 36146467 PMCID: PMC9505321 DOI: 10.3390/vaccines10091390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
Despite the implementation of widespread vaccination programs, the European Health Systems continue to experience care challenges attributable to organizational and structural issues. This study aimed to review the available data on aspects within the organizational and structural domains that might impact vaccination coverage. We searched a comprehensive range of databases from 1 January 2007 to 6 July 2021 for studies that reported quantitative or qualitative research on interventions to raise childhood vaccine coverage. Outcome assessments comprised organizational and structural factors that contribute to vaccine concern among pediatric parents, as well as data reported influencing the willingness to vaccinate. To analyze the risk of bias, the Ottawa, JBI’s (Joanna Briggs Institute) critical appraisal tool, and Amstar quality assessment were used accordingly. The inclusion criteria were met by 205 studies across 21 articles. The majority of the studies were conducted in the United Kingdom (6), the European Union (3), and Italy (3). A range of interventions studied in primary healthcare settings has been revealed to improve vaccination coverage rates including parental engagement and personalization, mandatory vaccination policies, program redesign, supply chain design, administering multiple/combination vaccines, improved vaccination timing and intervals, parental education and reminders, surveillance tools and Supplemental Immunisation Activity (SIA), and information model.
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Affiliation(s)
- Ronan Lemwel Valdecantos
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
- Global Health Workforce Network (GHWN) Youth Hub, World Health Organization, 1211 Geneva, Switzerland
- Correspondence: (R.L.V.); (R.P.)
| | - Raffaele Palladino
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University “Federico II” of Naples, 80138 Napoli, Italy
- Department of Primary Care and Public Health, Imperial College, London SW7 2BX, UK
- Correspondence: (R.L.V.); (R.P.)
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Section of Pediatrics, University “Federico II” of Naples, 80138 Napoli, Italy
| | - Emma Montella
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
| | - Maria Triassi
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
- Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), University “Federico II” of Naples, 80138 Napoli, Italy
| | - Antonio Nardone
- Department of Public Health, University “Federico II” of Naples, 80138 Napoli, Italy
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26
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Bekele AT, Nigus M, Wondwossen L, Karengera T, Tekle E, Mitula P, Assefu L, Kidane T, Yonas W. Estimation of infant vaccination coverage at national and region level in Ethiopia: a cross-sectional study. Pan Afr Med J 2022; 42:101. [PMID: 36034045 PMCID: PMC9391997 DOI: 10.11604/pamj.2022.42.101.18299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/18/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction an increasing trend of routine immunization performance has generally been observed over the past decade in Ethiopia. However, inconsistencies were observed over time and among different sources of data. This review analyzed systematically data from various sources and produced regional and national coverage estimates for antigens offered in the infant immunization program in Ethiopia. Methods we collated data from administrative reports, population-based surveys and other sources to produce annual estimates of vaccination coverage. We obtained relevant data for each of the 9 Regional States and 2 city administrations, for the period 2007-2016. Region level estimates were produced based on survey results, interpolation between or extrapolation. We aggregated the resulting region level estimates, using a population-weighted approach, to give national estimates. Results we found that the national Penta 3 coverage of Ethiopia increased from 59% in 2007 to 71% in 2016. For the 110 vaccination estimates produced at region level, 71 were based on interpolation or extrapolation from empirical anchor points; 18% were based on surveys and 17% were based on administrative data. Conclusion while we recognize the critical importance of improving the quality of information on vaccination coverage from administrative reporting systems, we are also cognizant of the expected continued need for region level surveys and improved rapid-monitoring exercises.
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Affiliation(s)
- Aschalew Teka Bekele
- Immunization Officer World Health Organization, Ethiopia Country Office, Addis Ababa, Ethiopia,,Corresponding author: Aschalew Teka Bekele, Immunization Officer World Health Organization, Ethiopia Country Office, Addis Ababa, Ethiopia.
| | - Mulat Nigus
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Thomas Karengera
- World Health Organization, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Ephrem Tekle
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Lemlem Assefu
- Immunization Officer World Health Organization, Ethiopia Country Office, Addis Ababa, Ethiopia
| | | | - Woldemichael Yonas
- World Health Organization, Ethiopia Country Office, Addis Ababa, Ethiopia
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Ateudjieu J, Yakum MN, Goura AP, Tembei Ayok M, Guenou E, Kangmo Sielinou CB, Kiadjieu FF, Tsafack M, Douanla Koutio IM, Tchio-Nighie KH, Tchokomeni H, Ntsekendio PN, Sack DA. An innovative approach in monitoring oral cholera vaccination campaign: integration of a between-round survey. BMC Public Health 2022; 22:238. [PMID: 35123444 PMCID: PMC8817499 DOI: 10.1186/s12889-022-12610-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/19/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Monitoring and Evaluation (M&E) is essential in ensuring population's access to immunization. Surveys are part of this M&E approach but its timing limits the use of its results to improve the coverage of the evaluated campaign. An oral cholera vaccination campaign was organized in a health district of the Far North region of Cameroon and involved an innovative M&E approach. The aim of this project was to assess the feasibility and effect of using recommendations of a community-based immunization and communication coverage survey conducted after the first round of an OCV campaign on the coverage of the second-round of the campaign. METHODS Two community-based surveys were included in the M&E plan and conducted at the end of each of the campaign rounds. Data were collected by trained and closely supervised surveyors and reported using smartphones. Key results of the first-round survey were disseminated to campaign implementing team prior to the second round. The two rounds of the pre-emptive campaign were organized by the Cameroon Ministry of Public Health and partners with a two-week interval in the Mogode Health District of the Far North region of Cameroon in May and June 2017. RESULTS Of 120 targeted clusters, 119 (99.1%) and 117 (97.5%) were reached for the first and second rounds respectively. Among the Mogode population eligible for vaccination, the immunization coverage based on evidence (card or finger mark) were estimated at 81.0% in the first round and increased to 88.8% in the second round (X2=69.0 and p <0.00). For the second round, we estimated 80.1% and 4.3% of persons who were administered 2 doses and 1 dose of OCV with evidence respectively, and 3.8% of persons who have not been vaccinated. The distribution of campaign communication coverage per health area was shared with the campaign coordination team for better planning of the second round campaign activities. CONCLUSIONS It is feasible to plan and implement coverage survey after first round OCV campaign and use its results for the better planning of the second round. For the present study, this is associated to the improvement of OCV coverage in the second-round vaccination. If this is persistent in other contexts, it may apply to improve coverage of any health campaign that is organized in more than one round.
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Affiliation(s)
- Jerôme Ateudjieu
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Division of Health Operations Research, Ministry of Public Health, Yaoundé, Cameroon
| | - Martin Ndinakie Yakum
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - André Pascal Goura
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - Maureen Tembei Ayok
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - Etienne Guenou
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
- Faculty of Sciences, University of Buea, Buea, Cameroon
| | | | - Frank Forex Kiadjieu
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - Marcellin Tsafack
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | | | - Ketina Hirma Tchio-Nighie
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Hervé Tchokomeni
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
| | - Paul Nyibio Ntsekendio
- Department of Health Research, M.A. SANTE (Meilleur Accès aux soins de Santé), Yaounde, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - David A. Sack
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Maugeri A, Barchitta M, Agodi A. Using Google Trends to Predict COVID-19 Vaccinations and Monitor Search Behaviours about Vaccines: A Retrospective Analysis of Italian Data. Vaccines (Basel) 2022; 10:vaccines10010119. [PMID: 35062780 PMCID: PMC8778420 DOI: 10.3390/vaccines10010119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
Google Trends data are an efficient source for analysing internet search behaviour and providing valuable insights into community dynamics and health-related problems. In this article, we aimed to evaluate if Google Trends data could help monitor the COVID-19 vaccination trend over time and if the introduction of COVID-19 vaccines modified the interest of pregnant women in vaccination. Data related to Google internet searches and the number of vaccine doses administered in Italy were used. We found moderate to strong correlations between search volumes of vaccine-related terms and the number of vaccines administered. In particular, a model based on Google Trends with a 3-week lag showed the best performance in fitting the number of COVID-19 vaccinations over time. We also observed that the introduction of COVID-19 vaccines affected the search interest for the argument “vaccination in pregnancy” both quantitatively and qualitatively. There was a significant increase in the search interest after the launch of the COVID-19 vaccination campaign in Italy. Qualitative analysis suggested that this increase was probably due to concerns about COVID-19 vaccines. Thus, our study suggests the benefits of using Google Trends data to predict the number of COVID-19 vaccine doses administered, and to monitor feelings about vaccination.
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Chiarella-Redfern H, Lee S, Jubran B, Sharifi N, Panaccione R, Constantinescu C, Benchimol EI, Seow CH. Suboptimal Vaccination Administration in Mothers With Inflammatory Bowel Disease and Their Biologic-Exposed Infants. Inflamm Bowel Dis 2022; 28:79-86. [PMID: 33609034 DOI: 10.1093/ibd/izab033] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pregnant women with inflammatory bowel disease (IBD) are at increased risk of developing complications from vaccine-preventable infections. We investigated the factors influencing vaccine administration in pregnant women with IBD and their infants, in addition to the safety of vaccination in the infants. METHODS This retrospective cohort study identified individuals from a tertiary referral clinic whose records were linked to a provincial vaccine database. We conducted χ 2 tests, Fisher exact tests, and logistic regression adjusting for age and disease duration to compare vaccine administration by medication class. Potential rotavirus vaccine adverse events were determined in infants of women with IBD. RESULTS We included 303 pregnant women and 262 infants. Vaccines were administered to women on biologic therapy as follows: hepatitis B virus (82.9%), diphtheria-tetanus-pertussis (82.1%), and hepatitis A virus (49.3%). The influenza vaccination was provided peripartum in 50.7% of patients. The measles-mumps-rubella-varicella vaccine was provided to 89.3% of women before biologic initiation. Women treated with a biologic (adjusted odds ratio, 2.50; 95% confidence interval, 1.39-4.35) or immunomodulator (adjusted odds ratio, 4.00; 95% confidence interval, 2.22-7.69) were more likely to receive the Prevnar 13 and Pneumovax 23 vaccines than were unexposed individuals, but the overall proportion vaccinated was low (Prevnar 13, 35.7%; Pneumovax 23, 39.3%). At least 90% of infants received the measles-mumps-rubella-varicella vaccine and inactivated vaccines. Fourteen biologic-exposed children (19.2%) received the live rotavirus vaccine with no significant differences in adverse events compared with biologic-unexposed infants (7.1% vs 8.2%, P = 0.99). CONCLUSIONS Better education surrounding vaccine recommendations is required for both health care providers and individuals with IBD given poor pneumococcal, hepatitis A virus, and influenza vaccination rates. Inadvertent administration of the rotavirus vaccine in biologic-exposed infants did not result in more adverse events, raising the possibility of safety.
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Affiliation(s)
| | - Sangmin Lee
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Bellal Jubran
- Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nastaran Sharifi
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
| | - Cora Constantinescu
- Division of Infectious Disease, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Cynthia H Seow
- Department of Community Health Sciences, University of Calgary, Alberta, Canada.,Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada
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Eze P, Aniebo CL, Agu UJ, Agu SA, Acharya Y. Validity of maternal recall for estimating childhood vaccination coverage - Evidence from Nigeria. Vaccine 2022; 40:28-36. [PMID: 34863616 DOI: 10.1016/j.vaccine.2021.11.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Vaccination coverage surveys in low- and middle-income countries typically estimate vaccination coverage using data from vaccination cards, parental recall, or a combination of the two. However, these surveys are often complicated by the pervasive absence of vaccination cards, forcing researchers to rely on parental recall. We assessed the validity of mothers' recall against home-based vaccination cards using data from a community-based household survey in Nigeria. METHODS A cross-sectional survey of 1,254 mothers of children aged 12-23 months was performed in Enugu State, Nigeria in July 2020. Data on vaccination status for BCG, OPV, DPT, Measles, Yellow fever, and Vitamin A supplement were collected using two data sources: home-based vaccination cards and mothers' recall. We evaluated the level of agreement between the two data sources; estimated the sensitivity and specificity of mothers' recalls; and computed multivariable regression models to identify socio-demographic factors associated with mothers' recall bias. RESULTS Out of 1,254 mothers interviewed, 578 (46.1%) mothers with vaccination cards were included in this analysis. Vaccination coverage levels were generally similar across data sources, though recall-based data generally underestimated the coverage. The level of agreement between the two data sources was high (≥91.0% for all vaccine types) with recall bias due to under-reporting generally higher than recall bias due to over-reporting. The sensitivity of parental recalls was high for all vaccine types, while the specificity was low across vaccine types. Across all vaccines, mothers recall bias was significantly associated with the rural residence and not receiving postnatal care. CONCLUSION In the absence of vaccination cards, mothers' recall of their children' vaccination status for BCG, OPV, DPT, Measles, Yellow fever and Vitamin A is a valid instrument for estimating childhood vaccination coverage in this setting in Nigeria. However, additional research is needed to confirm these findings at higher sub-national and national levels.
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Affiliation(s)
- Paul Eze
- Department of Health Policy and Administration, Penn State University, University Park, PA 16802, USA.
| | - Chioma Lynda Aniebo
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Ujunwa Justina Agu
- Department of Paediatrics, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
| | - Sergius Alex Agu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Yubraj Acharya
- Department of Health Policy and Administration, Penn State University, University Park, PA 16802, USA.
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Barroso Rodrigues S, Gonçalves Amaral G, Santos Silva B, Cunha Corrêa Freitas de Oliveira G, Oliveira de Moraes Tavares L, de Oliveira VC, Albano de Azevedo Guimarães E. Uso do Sistema de Informação de Imunização do Brasil: qual a realidade? REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: A informação em saúde é essencial na tomada de decisões no âmbito das políticas públicas e tem se apresentado como instrumento essencial na interpretação de fenômenos. Assim, o estudo teve como objetivo avaliar o uso do Sistema de Informação de Imunização pelos profissionais de enfermagem. Materiais e métodos: Estudo transversal analítico realizado num município da Macrorregião Oeste de Minas Gerais, com profissionais de enfermagem por meio de um checklist validado. Para análise, utilizou-se um sistema de escores, classificado como: adequado, parcialmente adequado, não adequado e crítico. A mediana foi utilizada como medida-resumo para a análise descritiva e o Teste Qui-Quadrado de Pearson, para comparação de proporções. Resultados: Dos 104 profissionais de enfermagem, 14,4% relatam fazer uso dos registros para a gestão da informação em vacinação, 93,3% realizam o controle de estoque dos imunobiológicos, sendo esta a única atividade classificada como adequada. A produção do relatório de listagem de faltosos (39,4%), produção do relatório de cobertura vacinal (36,5%) e divulgação das informações consolidadas produzidas (17,3%) foram classificados como críticos. Não houve associações estatisticamente significativas entre as variáveis estudadas. Discussão: A subutilização das informações do sistema de informação traz consequências para os serviços de imunização, como baixas coberturas vacinais e oscilações nas proporções de abandono, além dificultar o planejamento e a tomada de decisões dos gestores das salas de vacinação. Conclusões: O uso das informações dos sistemas de informação precisa ser reconhecido pelos profissionais como necessário, útil e aplicável, sendo parte do processo de trabalho em sala de vacinação.
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Sawadogo-Lewis T, Keita Y, Wilson E, Sawadogo S, Téréra I, Sangho H, Munos M. Can We Use Routine Data for Strategic Decision Making? A Time Trend Comparison Between Survey and Routine Data in Mali. GLOBAL HEALTH: SCIENCE AND PRACTICE 2021; 9:869-880. [PMID: 34933982 PMCID: PMC8691880 DOI: 10.9745/ghsp-d-21-00281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022]
Abstract
Routine data, which is available more regularly than the "gold standard" survey data, can be used to inform programmatic decisions in Mali at the national level. However, caution must be used if using data at a subnational level. Background: Countries with scarce resources need timely and high-quality data on coverage of health interventions to make strategic decisions about where to allocate investments in health. Household survey data are generally regarded as “gold standard,” high-quality data. This study assessed the comparability of intervention coverage time trends from routine and survey data at national and subnational levels in Mali. Methods: We compared 3 coverage indicators: contraceptive prevalence rate, institutional delivery, and 3 doses of diphtheria, pertussis, and tetanus (DPT3) vaccine, using 3 Mali Demographic and Health Surveys (DHS 2001, 2006, and 2012–2013) and routine health system data covering 2001–2012. For routine data, we used local health information system (HIS) annual reports and an HIS database. To compare time trends between the data sources, we calculated the percentage point change and 95% confidence interval from 2001–2006 and 2006–2012. We then computed the absolute and relative differences between the 2 data sources for each indicator over time at national and regional levels and assessed their level of significance. Results: The direction and magnitude of the time trends of contraceptive prevalence rate, institutional delivery, and DPT3 vaccine from 2001 to 2012 were similar at the national level between data sources. At the regional level, there were significant differences in the magnitude and direction of time trends for institutional delivery and the DPT3 vaccine; contraceptive prevalence trends were more consistent. Routine data tended to overestimate DPT3 coverage, and underestimate institutional delivery and contraceptive prevalence relative to survey data. Conclusion: Routine data in Mali—particularly at the national level—appear to be appropriate for use to inform program planning and prioritization, but routine time trends should be interpreted with caution at the subnational level. For program evaluations, routine data may not be appropriate to draw accurate inferences about program impact.
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Affiliation(s)
- Talata Sawadogo-Lewis
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Youssouf Keita
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Bamako, Mali
| | - Emily Wilson
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ibrahim Téréra
- Institut National de la Santé Publique (INSP), Bamako, Mali
| | | | - Melinda Munos
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Dong TQ, Wakefield J. Space-time smoothing models for subnational measles routine immunization coverage estimation with complex survey data. Ann Appl Stat 2021. [DOI: 10.1214/21-aoas1474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Tracy Qi Dong
- Department of Biostatistics, University of Washington
| | - Jon Wakefield
- Departments of Biostatistics and Statistics, University of Washington
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Mwinnyaa G, Hazel E, Maïga A, Amouzou A. Estimating population-based coverage of reproductive, maternal, newborn, and child health (RMNCH) interventions from health management information systems: a comprehensive review. BMC Health Serv Res 2021; 21:1083. [PMID: 34689787 PMCID: PMC8542459 DOI: 10.1186/s12913-021-06995-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/15/2022] Open
Abstract
Background Routinely collected health facility data usually captured and stored in Health Management Information Systems (HMIS) are potential sources of data for frequent and local disaggregated estimation of the coverage of reproductive, maternal, newborn, and child health interventions (RMNCH), but have been under-utilized due to concerns over data quality. We reviewed methods for estimation of national or subnational coverage of RMNCH interventions using HMIS data exclusively or in conjunction with survey data from low- and middle-income countries (LMICs). Methods We conducted a comprehensive review of studies indexed in PubMed and Scopus to identify potential papers based on predefined search terms. Two reviewers screened the papers using defined inclusion and exclusion criteria. Following sequences of title, abstract and full paper reviews, we retained 18 relevant papers. Results 12 papers used only HMIS data and 6 used both HMIS and survey data. There is enormous lack of standards in the existing methods for estimating RMNCH intervention coverage; all appearing to be highly author dependent. The denominators for coverage measures were estimated using census, non-census and combined projection-based methods. No satisfactory methods were found for treatment-based coverage indicators for which the estimation of target population requires the population prevalence of underlying conditions. The estimates of numerators for the coverage measures were obtained from the count of users or visits and in some cases correction for completeness of reporting in the HMIS following an assessment of data quality. Conclusions Standard methods for correcting numerators from HMIS data for accurate estimation of coverage of RMNCH interventions are needed to expand the use of these data. More research and investments are required to improve denominators for health facility-derived statistics. Improvement in routine data quality and analytical methods would allow for timely estimation of RMNCH intervention coverage at the national and subnational levels.
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Affiliation(s)
- George Mwinnyaa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, MD, 21205, Baltimore, USA
| | - Elizabeth Hazel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, MD, 21205, Baltimore, USA
| | - Abdoulaye Maïga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, MD, 21205, Baltimore, USA
| | - Agbessi Amouzou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, MD, 21205, Baltimore, USA.
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Francis MR, Nuorti JP, Lumme-Sandt K, Kompithra RZ, Balraj V, Kang G, Mohan VR. Vaccination coverage and the factors influencing routine childhood vaccination uptake among communities experiencing disadvantage in Vellore, southern India: a mixed-methods study. BMC Public Health 2021; 21:1807. [PMID: 34620139 PMCID: PMC8499461 DOI: 10.1186/s12889-021-11881-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2015, the Vellore district in southern India was selected for intensified routine immunization, targeting children from communities experiencing disadvantage such as migrant, tribal, and other hard-to-reach groups. This mixed-methods study was conducted to assess routine immunization coverage and the factors influencing childhood vaccination uptake among these communities in Vellore. METHODS We conducted a cross-sectional household survey (n = 100) and six focus group discussions (n = 43) among parents of children aged 12-23 months from the known communities experiencing disadvantage in Vellore during 2017 and 2018. Multivariate logistic regression was conducted to examine associations between the parental characteristics and children's vaccination status in the household survey data; the qualitative discussions were analyzed by using the (previously published) "5As" taxonomy for the determinants of vaccine uptake. RESULTS In the household survey, the proportions of fully vaccinated children were 65% (95% CI: 53-76%) and 77% (95% CI: 58-88%) based on information from vaccination cards or parental recall and vaccination cards alone, respectively. Children whose mothers were wage earners [Adjusted prevalence odds ratio (aPOR): 0.21, 95% CI = 0.07-0.64], or salaried/small business owners [aPOR: 0.18, 95% CI = 0.04-0.73] were less likely to be fully vaccinated than children who had homemakers mothers. In the focus group discussions, parents identified difficulties in accessing routine immunization when travelling for work and showed knowledge gaps regarding the benefits and risks of vaccination, and fears surrounding certain vaccines due to negative news reports and common side-effects following childhood vaccination. CONCLUSIONS Vaccination coverage among children from the surveyed communities in Vellore was suboptimal. Our findings suggest the need to target children from Narikuravar families and conduct periodic community-based health education campaigns to improve parental awareness about and trust in childhood vaccines among the communities experiencing disadvantage in Vellore.
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Affiliation(s)
- Mark Rohit Francis
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - J Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Infectious Diseases and Vaccines Unit, Department of Health Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - Kirsi Lumme-Sandt
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Rajeev Zachariah Kompithra
- Well Baby Immunization Clinic, Department of Pediatrics Unit - I, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinohar Balraj
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Venkata Raghava Mohan
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India.
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Xu X, Rodgers MD, Guo WG. A hub-and-spoke design for ultra-cold COVID-19 vaccine distribution. Vaccine 2021; 39:6127-6136. [PMID: 34509324 PMCID: PMC8384589 DOI: 10.1016/j.vaccine.2021.08.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/22/2021] [Accepted: 08/19/2021] [Indexed: 10/27/2022]
Abstract
An orderly and effective vaccination campaign is essential in combating the global COVID-19 pandemic. As one of the pioneers, the U.S. Center for Disease Control proposes a phased plan to promote the vaccination process. This plan starts with vaccinating the high-priority population in Phase 1, then turns to the remainder of the public in Phase 2, and ends with a scale-back network in Phase 3. The phased plan not only provides a sense of hope to impacted communities that this global pandemic can be defeated, but can serve as a template for other countries. To enhance this plan, this paper develops a generalizable framework for designing a hub-and-spoke vaccination dispensing network to achieve the goals in the Phase 2, which aims to expand the vaccination coverage for the general public. We introduce a new coverage index to measure the priority of different potential dispensing sites based on geo-data and develop an optimization model for network design. The hub-and-spoke network enhances the accessibility of the vaccines to various communities and helps to overcome the challenges related to ultra-cold storage facility shortage. A case study of Middlesex County in New Jersey is presented to demonstrate the application of the framework and provide insights for the Phase 2. Results from the baseline scenario show that increasing the driving time limit from 10 min to 25 min can improve the total coverage index from 40.8 to 55.9. Additionally, we explore how the changes of parameters impact the network design and discuss potential solutions for some special cases. When we allow 4 outreach nodes per hub, all potential 45 outreach points can be covered in the vaccination network within a 20-minute drive, and the total coverage index reaches its maximum value of 58.3.
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Affiliation(s)
- Xinglu Xu
- Department of Industrial and Systems Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA; State Key Laboratory of Coastal and Offshore Engineering, Dalian University of Technology, No.2 Linggong Road, Ganjingzi District, Dalian, Liaoning 116023, China
| | - Mark D Rodgers
- Department of Supply Chain Management, Rutgers Business School, Rutgers, The State University of New Jersey, Piscataway, NJ 07102, USA
| | - Weihong Grace Guo
- Department of Industrial and Systems Engineering, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA.
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Campbell JD, Pasetti MF, Oot L, Adam Z, Tefera M, Beyane B, Mulholland N, Steinglass R, Krey R, Chen WH, Blackwelder WC, Levine MM. Linked vaccination coverage surveys plus serosurveys among Ethiopian toddlers undertaken three years apart to compare coverage and serologic evidence of protection in districts implementing the RED-QI approach. Vaccine 2021; 39:5802-5813. [PMID: 34465472 PMCID: PMC8494116 DOI: 10.1016/j.vaccine.2021.08.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022]
Abstract
A seroprotective tetanus titer indicates a toddler has received pentavalent vaccine. Serosurveys document increased seroprevalence post-measles vaccination campaigns. Vaccination coverage/serosurveys can assess interventions to improve immunizations.
In low and middle-income countries, estimating the proportion of vaccinated toddlers in a population is important for controlling vaccine-preventable diseases by identifying districts where immunization services need strengthening. Estimates measured before and several years after specific interventions can assess program performance. However, employing different methods to derive vaccination coverage estimates often yield differing results. Methods Linked vaccination coverage surveys and seroprotection surveys performed among ~300 toddlers 12–23 months of age in districts (woredas), one per region, of Ethiopia (total, ~900 toddlers) in 2013 to estimate the proportion vaccinated with tetanus toxoid (a proxy for pentavalent vaccine) and measles vaccine. The surveys were followed by implementation of the Reaching Every District using Quality Improvement (RED-QI) approach to strengthen the immunization system. Linked coverage/serosurveys were repeated in 2016 to assess effects of the interventions on vaccination coverage. Indicators included “documented coverage” (vaccination card and/or health facility register records) and “crude coverage” (documented plus parent/caretaker recall for children without cards). Seroprotection thresholds were IgG-ELISA tetanus antitoxin ≥0.05 IU/ml and plaque reduction neutralization (PRN) measles titers ≥120 mIU/ml. Findings Improved markers in 2016 over 2013 include coverage of pentavalent vaccination, vaccination timeliness, and fewer missed opportunities to vaccinate. In parallel, tetanus seroprotection increased in the 3 woredas from 59.6% to 79.1%, 72.9% to 83.7%, and 94.3 to 99.3%. In 2015, the Ethiopian government conducted supplemental measles mass vaccination campaigns in several regions including one that involved a project woreda and the campaign overlapped with the RED-QI intervention timeframe; protective measles PRN titers there rose from 31.0% to 50.0%. Interpretation The prevalence of seroprotective titers of tetanus antitoxin (stimulated by tetanus toxoid components within pentavalent vaccine) provides a reliable biomarker to identify children who received pentavalent vaccine. In the three study woredas, the RED-QI intervention appeared to improve immunization service delivery, as documented by enhanced pentavalent vaccine coverage, vaccination timeliness, and fewer missed vaccination opportunities. A measles mass vaccination campaign was followed by a markedly increased prevalence of measles PRN antibodies. Collectively, these observations suggest that wider implementation of RED-QI can strengthen immunization, and periodic linked vaccination surveys/serosurveys can monitor changes.
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Affiliation(s)
- James D Campbell
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Marcela F Pasetti
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Lisa Oot
- JSI Research & Training Institute Inc., Arlington, VA, USA
| | - Zenaw Adam
- JSI Research & Training Institute Inc., Arlington, VA, USA
| | - Mesfin Tefera
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Berhane Beyane
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Nigisti Mulholland
- Family & Reproductive Rights Education Program (FARREP), The Royal Women's Hospital, Parkville, VIC 3052, Australia
| | | | - Rebecca Krey
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Wilbur H Chen
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - William C Blackwelder
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Myron M Levine
- Center for Vaccine Development and Global Health, Baltimore, MD 21201, USA; Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Chan J, Mungun T, Batsaixan P, Ulziibayar M, Suuri B, Otgonbayar D, Luvsantseren D, Nguyen CD, Narangarel D, Dunne EM, Fox K, Hinds J, Nation ML, Pell CL, Mulholland EK, Satzke C, von Mollendorf C, Russell FM. Direct and indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with pneumonia from formal and informal settlements in Mongolia: an observational study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100231. [PMID: 34528012 PMCID: PMC8342962 DOI: 10.1016/j.lanwpc.2021.100231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
Background Within Ulaanbaatar, Mongolia, risk factors for pneumonia are concentrated among children living in informal settlements comprised of temporary shelters (gers). We used pneumococcal carriage surveillance among children from formal and informal settlements hospitalised with pneumonia to evaluate the direct and indirect effects of 13-valent pneumococcal conjugate vaccine (PCV13) against vaccine-type (VT) pneumococcal carriage following a phased introduction of PCV13. Methods We enrolled and collected nasopharyngeal swabs from children 2-59 months of age presenting to hospital. Pneumococci were detected using lytA qPCR and serotyped using microarray on a random monthly selection of swabs between November 2015 and March 2019 from two districts in Ulaanbaatar. PCV13 status was determined using written records. We quantified the associations between individual PCV13 status (direct effects) and district-level PCV13 coverage (indirect effects) and VT carriage using generalised estimating equations and explored interactions by settlement type. Findings A total of 1 292 swabs from 6 046 participants were tested for pneumococci. Receipt of PCV13 and increasing PCV13 coverage independently reduced the risk of VT carriage. For each percent increase in PCV13 coverage, the adjusted odds of VT carriage decreased by 1•0% (OR 95% CI 0•983-0•996; p=0•001), with a predicted decrease in VT carriage rate from 29•1% to 13•1% as coverage reached 100%. There was a trend towards a slower decline within informal settlements (p=0•100). Adjusted PCV13 vaccine effectiveness against VT carriage was 39•1% (95% CI 11•4-58•1%, p=0•009). Interpretation Substantial indirect effects were observed following PCV13 introduction, including among children living within informal settlements. Funding Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance.
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Affiliation(s)
- Jocelyn Chan
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tuya Mungun
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Purevsuren Batsaixan
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Mukhchuluun Ulziibayar
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Bujinlkham Suuri
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Dashpagam Otgonbayar
- National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Dashtseren Luvsantseren
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Dorj Narangarel
- National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Eileen M Dunne
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - Kimberley Fox
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | - Jason Hinds
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom.,BUGS Bioscience, London Bioscience Innovation Centre, London, United Kingdom
| | - Monica L Nation
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - Casey L Pell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - E Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Claire von Mollendorf
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Pond B, Bekele A, Mounier-Jack S, Teklie H, Getachew T. Estimation of Ethiopia's immunization coverage - 20 years of discrepancies. BMC Health Serv Res 2021; 21:587. [PMID: 34511081 PMCID: PMC8436460 DOI: 10.1186/s12913-021-06568-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Coverage with the third dose of diphtheria-pertussis-tetanus-containing vaccine (DPT3) is a widely used measure of the performance of routine immunization systems. Since 2015, data reported by Ethiopia’s health facilities have suggested DPT3 coverage to be greater than 95%. Yet, Demographic and Health Surveys in 2016 and 2019 found DPT3 coverage to be 53 and 61% respectively for years during this period. This case study reviews the last 20 years of administrative (based on facility data), survey and United Nations (UN) estimates of Ethiopia’s nationwide immunization coverage to document long-standing discrepancies in these statistics. Methods Published estimates were compiled of Ethiopia’s nationwide DPT3 coverage from 1999 to 2018. These estimates come from the Joint Reporting Form submitted annually to WHO and UNICEF, a series of 8 population-based surveys and the annual reports of the WHO/UNICEF Estimates of National Immunization Coverage (WUENIC). Possible reasons for variation in survey findings were explored through secondary analysis of data from the 2012 immunization coverage survey. In addition, selected health officials involved with management of the immunization program were interviewed to obtain their perspectives on the reliability of various methods for estimation of immunization coverage. Findings Comparison of Ethiopia’s estimates for the same year from different sources shows major and persistent discrepancies between administrative, survey and WUENIC estimates. Moreover, the estimates from each of these sources have repeatedly shown erratic year-to-year fluctuations. Those who were interviewed expressed scepticism of Demographic and Health Survey (DHS) statistics. Officials of the national immunization programme have repeatedly shown a tendency to overlook all survey statistics when reporting on programme performance. Conclusions The present case study raises important questions, not only about the estimation methods of national and UN agencies, but about the reliability and comparability of widely trusted coverage surveys. Ethiopia provides an important example of a country where no data source provides a truly robust “gold standard” for estimation of immunization coverage. It is essential to identify and address the reasons for these discrepancies and arrive at a consensus on how to improve the reliability and acceptability of each data source and how best to “triangulate” between them. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06568-0.
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Affiliation(s)
- Bob Pond
- Independent public health analyst, Camas, WA, 98607, USA.
| | - Abebe Bekele
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | | | - Habtamu Teklie
- Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
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40
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Danovaro-Holliday MC, Kretsinger K, Gacic-Dobo M. Measuring and ensuring routine childhood vaccination coverage. Lancet 2021; 398:468-469. [PMID: 34273296 DOI: 10.1016/s0140-6736(21)01228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - Katrina Kretsinger
- Immunizations, Vaccines & Biologicals, World Health Organization, Geneva 1211, Switzerland.
| | - Marta Gacic-Dobo
- Immunizations, Vaccines & Biologicals, World Health Organization, Geneva 1211, Switzerland
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Ori PU, Adebowale A, Umeokonkwo CD, Osigwe U, Balogun MS. Descriptive epidemiology of measles cases in Bauchi State, 2013-2018. BMC Public Health 2021; 21:1311. [PMID: 34225675 PMCID: PMC8256615 DOI: 10.1186/s12889-021-11063-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/14/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Measles accounts for high morbidity and mortality in children, especially in developing countries. In 2017, about 11,190 measles cases were recorded in Nigeria, including Bauchi State. The aim of this study was to describe the trend and burden of measles in Bauchi State, Nigeria. METHOD We analyzed secondary data of measles cases extracted from the Measles Surveillance data system in Bauchi State from January 2013 to June 2018. The variables extracted included age, sex, doses of vaccination, case location and outcome. Data were analyzed using descriptive statistics, logistic regression, and multiplicative time series model (α = 0.05). RESULTS A total of 4935 suspected measles cases with an average annual incidence rate of 15.3 per 100,000 population and 57 deaths (Case Fatality Rate, CFR: 1.15%) were reported. Among the reported cases, 294 (6%;) were laboratory-confirmed, while clinically compatible and epi-linked cases were 402 (8%) and 3879 (70%), respectively. Of the 4935 measles cases, 2576 (52%) were males, 440 (9%) were under 1 year of age, and 3289 (67%) were between 1 and 4 years. The average annual incidence rate among the 1-4 year age-group was 70.3 per 100,000 population. The incidence rate was lowest in 2018 with 2.1 per 100,000 and highest in 2015 with 26.2 per 100,000 population. The measles cases variation index per quarter was highest in quarter 1 (198.86), followed by quarter 2 (62.21) and least in quarter 4 (10.37) of every year. Only 889 (18%) of the measles cases received at least one dose of measles vaccine, 2701 (54.7%) had no history of measles vaccination while 1346 (27.3%) had unknown vaccination status. The fatality of measles in Bauchi State were significantly associated with being under 5 years (AOR = 5.58; 95%CI: 2.19-14.22) and not having at least a dose of MCV (OR = 7.14; 95%CI: 3.70-14.29). CONCLUSION Measles burden remains high in Bauchi State despite a decrease in its incidence over the study years. Most of the cases occurred in the first quarter of every year. Improved routine measles surveillance for prompt case management could reduce the burden of the disease in Bauchi State.
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Affiliation(s)
| | - Ayo Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Chukwuma David Umeokonkwo
- Nigerian Field Epidemiology and Laboratory and Training Programme, Abuja, Nigeria
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State Nigeria
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Chan J, Lai JYR, Nguyen CD, Vilivong K, Dunne EM, Dubot-Pérès A, Fox K, Hinds J, Moore KA, Nation ML, Pell CL, Xeuatvongsa A, Vongsouvath M, Newton PN, Mulholland K, Satzke C, Dance DAB, Russell FM. Indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with acute respiratory infection despite heterogeneous vaccine coverage: an observational study in Lao People's Democratic Republic. BMJ Glob Health 2021; 6:bmjgh-2021-005187. [PMID: 34108146 PMCID: PMC8191607 DOI: 10.1136/bmjgh-2021-005187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Empiric data on indirect (herd) effects of pneumococcal conjugate vaccines (PCVs) in settings with low or heterogeneous PCV coverage are limited. The indirect effects of PCV, which benefits both vaccinated and non-vaccinated individuals, are mediated by reductions in vaccine-type (VT) carriage (a prerequisite for disease). The aim of this study among hospitalised children in Lao People’s Democratic Republic (Lao PDR) is to determine the effectiveness of a 13-valent PCV (PCV13) against VT pneumococcal nasopharyngeal carriage (direct effects) and the association between village-level PCV13 coverage and VT carriage (indirect effects). Methods Pneumococcal nasopharyngeal carriage surveillance commenced in December 2013, shortly after PCV13 introduction (October 2013). We recruited and swabbed children aged 2–59 months admitted to hospital with acute respiratory infection. Pneumococci were detected using lytA quantitative real-time PCR and serotyped using microarray. PCV13 status and village-level PCV13 coverage were determined using written immunisation records. Associations between both PCV13 status and village-level PCV13 coverage and VT carriage were calculated using generalised estimating equations, controlling for potential confounders. Results We enrolled 1423 participants and determined PCV13 coverage for 368 villages (269 863 children aged under 5 years). By 2017, median village-level vaccine coverage reached 37.5%, however, the IQR indicated wide variation among villages (24.1–56.4). Both receipt of PCV13 and the level of PCV13 coverage were independently associated with a reduced odds of VT carriage: adjusted PCV13 effectiveness was 38.1% (95% CI 4.1% to 60.0%; p=0.032); and for each per cent increase in PCV13 coverage, the estimated odds of VT carriage decreased by 1.1% (95% CI 0.0% to 2.2%; p=0.056). After adjustment, VT carriage decreased from 20.0% to 12.8% as PCV13 coverage increased from zero to 60% among under 5. Conclusions Despite marked heterogeneity in PCV13 coverage, we found evidence of indirect effects in Lao PDR. Individual vaccination with PCV13 was effective against VT carriage.
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Affiliation(s)
- Jocelyn Chan
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Jana Y R Lai
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Keoudomphone Vilivong
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic
| | - Eileen M Dunne
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Audrey Dubot-Pérès
- Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic.,Unité des Virus Émergents, UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection, Marseille, France
| | - Kimberley Fox
- Regional Office for the Western Pacific, World Health Organization (WHO), Manila, Philippines
| | - Jason Hinds
- Institute for Infection and Immunity, St George's University of London, London, UK.,BUGS Bioscience London Bioscience Innovation Centre, London, UK
| | - Kerryn A Moore
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Monica L Nation
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Casey L Pell
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Anonh Xeuatvongsa
- National Immunization Programme, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | | | - Paul N Newton
- Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Kim Mulholland
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Catherine Satzke
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - David A B Dance
- Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Fiona M Russell
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
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Garcia ÉM, Murakami Junior J, Costa ÂA, Inenami M, Figueiredo WM, Waldman EA, Sato APS. Computerized immunization record agreement in Araraquara, São Paulo, Brazil, 2018. ACTA ACUST UNITED AC 2021; 30:e2020854. [PMID: 34133641 DOI: 10.1590/s1679-49742021000200023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe agreement between the Juarez System immunization data and information in vaccination record booklets and vaccination coverage in children aged 12 to 24 months. METHODS This was a descriptive study to assess the vaccination status at 12 and 24 months of age of children born in 2015 and recorded on the Juarez System. The levels of agreement between the Juarez System data and the information in vaccination record booklets were verified. RESULTS 429 children were included. It was found that agreement ranged between 84.1% and 99.1%. The vaccine survey found that coverage for each vaccine ranged from 86.01% to 100% and for the full schedule, from 77.1% (12 months) to 68.8% (24 months). The spatial distributions of vaccine coverage ranged from 28% to 100%. CONCLUSION There was excellent agreement between the data, with high vaccination coverage, but heterogeneity in their spatial distributions.
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Affiliation(s)
| | | | | | - Marta Inenami
- Universidade de São Paulo, Faculdade de Saúde Pública, São Paulo, SP, Brasil
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Santos TM, Cata-Preta BO, Victora CG, Barros AJD. Finding Children with High Risk of Non-Vaccination in 92 Low- and Middle-Income Countries: A Decision Tree Approach. Vaccines (Basel) 2021; 9:vaccines9060646. [PMID: 34199179 PMCID: PMC8231774 DOI: 10.3390/vaccines9060646] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
Reducing vaccination inequalities is a key goal of the Immunization Agenda 2030. Our main objective was to identify high-risk groups of children who received no vaccines (zero-dose children). A decision tree approach was used for 92 low- and middle-income countries using data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys, allowing the identification of groups of children aged 12–23 months at high risk of being zero dose (no doses of the four basic vaccines—BCG, polio, DPT and measles). Three high-risk groups were identified in the analysis combining all countries. The group with the highest zero-dose prevalence (42%) included 4% of all children, but almost one in every four zero-dose children in the sample. It included children whose mothers did not receive the tetanus vaccine during and before the pregnancy, who had no antenatal care visits and who did not deliver in a health facility. Separate analyses by country presented similar results. Children who have been missed by vaccination services were also left out by other primary health care interventions, especially those related to antenatal and delivery care. There is an opportunity for better integration among services in order to achieve high and equitable immunization coverage.
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Development of a Measles and Rubella Multiplex Bead Serological Assay for Assessing Population Immunity. J Clin Microbiol 2021; 59:JCM.02716-20. [PMID: 33731416 DOI: 10.1128/jcm.02716-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/11/2021] [Indexed: 02/01/2023] Open
Abstract
Serosurveys are important tools for estimating population immunity and providing immunization activity guidance. The measles and rubella multiplex bead assay (MBA) offers multiple advantages over standard serological assays and was validated by comparison with the enzyme-linked immunosorbent assay (ELISA) and the measles plaque reduction neutralization (PRN) assay. Results from a laboratory-produced purified measles virus whole-virus antigen MBA (MeV WVAL) correlated better with ELISA and PRN than results from the baculovirus-expressed measles nucleoprotein (N) MBA. Therefore, a commercially produced whole-virus antigen (MeV WVAC) was evaluated. Serum IgG antibody concentrations correlated significantly with a strong linear relationship between the MeV WVAC and MeV WVAL MBAs (R = 0.962 and R 2 = 0.926). IgG concentrations from the MeV WVAC MBA showed strong correlation with PRN titers (R = 0.846), with a linear relationship comparable to values obtained with the MeV WVAL MBA and PRN assay (R 2 = 0.716 and R 2 = 0.768, respectively). Receiver operating characteristic (ROC) curve analysis of the MeV WVAC using PRN titer as the comparator resulted in a seroprotection cutoff of 153 mIU/ml, similar to the established correlate of protection of 120 mIU/ml, with a sensitivity of 98% and a specificity of 83%. IgG concentrations correlated strongly between the rubella WVA MBA and ELISA (R = 0.959 and R 2 = 0.919). ROC analysis of the rubella MBA using ELISA as the comparator yielded a cutoff of 9.36 IU/ml, similar to the accepted cutoff of 10 IU/ml for seroprotection, with a sensitivity of 99% and a specificity of 100%. These results support use of the MBA for multiantigen serosurveys assessing measles and rubella population immunity.
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Rios-Blancas MJ, Lamadrid-Figueroa H, Betancourt-Cravioto M, Lozano R. Vaccination coverage estimation in Mexico in children under five years old: Trends and associated factors. PLoS One 2021; 16:e0250172. [PMID: 33861792 PMCID: PMC8051786 DOI: 10.1371/journal.pone.0250172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
We aimed to estimate vaccination coverage and factors associated in completing schemes in children under 5 years old between 2000 and 2018. A secondary analysis was carried out on five national health surveys between 2000 and 2018 in Mexico. The sample was 53,898 children under 5 years old, where 30% of missing vaccination information was imputed using chained equations. During this period two basic vaccination schemes (CBS) were identified. For each doses and vaccines of both schemes and completed CBS, the coverage was estimated using weighted logistic regression models. Additionally, the factors associated with incomplete schemes were reported. Between 2000 and 2018, the caretakers who did not show the vaccination card went from 13.8% to 45.6%. During this period, the estimated vaccination coverages did not exceed 95%, except for BCG and marginally the first doses of vaccines against pneumococcus, acellular pentavalent, and Sabin. In the same period, the CBS estimated coverage decreased steadily and was under 90%, except for children aged 6-11 months (92.6%; 91.5-93.7) in 2000. Not having health insurance stands out as an associated factor with incomplete vaccination schemes. In conclusion, the imputation allowed to recuperate information and obtain better data of vaccination coverage. The estimated vaccination coverage and CBS do not reach sufficient levels to guarantee herd immunity, hence innovative strategies to improve vaccination must be established in Mexico.
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Affiliation(s)
| | | | | | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
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Brown DW, Danovaro-Holliday MC, Rhoda DA. Pairs of independent nationally representative vaccination coverage surveys conducted within one year of each other: A global overview covering 2000-2019. Vaccine X 2021; 7:100085. [PMID: 33644743 PMCID: PMC7887424 DOI: 10.1016/j.jvacx.2021.100085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background Population-based surveys play an important role in measuring vaccination coverage. Surveys measuring vaccination coverage may be commissioned by the Expanded Programme on Immunization (EPI surveys) or part of multi-domain non-EPI surveys such as Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS). Surveys conducted too close in time to each other may not only be an inefficient use of resources but may also create problems for programme staff when results suggest inconsistent patterns of programme performance for similar time periods. Objective To summarize the occurrence of vaccination coverage surveys conducted close in time during 2000–2019 and compare results of EPI and non-EPI coverage surveys when the surveys were conducted within one year of each other. Methods Using a database of published national-level vaccination coverage survey results compiled by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), the authors abstracted information on survey field work dates, sample size, percentage of children with documented history of vaccination and the percent coverage, as well as published uncertainty intervals from DHS and MICS, for the first and third doses of diphtheria-tetanus toxoid-pertussis containing vaccine (DTP1, DTP3) and first dose of measles containing vaccine (MCV1). Survey results of EPI and non-EPI surveys were compared. Results The authors identified 646 surveys with final reports and estimates of national-level vaccination coverage for DTP1, DTP3, or MCV1 from a total of 687 surveys with data collection start date from 2000 to 2019. Of the 140 countries with at least one vaccination coverage survey, a median of four surveys was observed. Most countries were Gavi-eligible and located in the WHO Africa Region. Sixty-six survey dyads were identified where an EPI survey occurred within one year of a non-EPI survey. For the 66 dyads, in 49 of 59 with information available, EPI surveys reported higher proportion of documented evidence of vaccination and EPI survey results tended to suggest higher levels of vaccination coverage compared to the non-EPI surveys; quite often, differences were substantial. Surveys that found higher proportions of children with documented vaccination evidence tended to also find higher proportions of children who had been vaccinated. Summary Opportunities exist to improve overall planning of vaccination coverage measurement in population-based household surveys so that both EPI and non-EPI surveys are more comparable and survey coverage estimates are more appropriately spaced in time. When surveys occur too close in time, careful attention is warranted to ensure comparability and assess sources of documented evidence of vaccination and related coverage differences.
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Affiliation(s)
- David W. Brown
- BCGI LLC/pivot-23.5°, Cornelius, NC, USA
- Corresponding author at: BCGI LLC/pivot-23.5°, 19701 Bethel Church Road, Ste 103-168, Cornelius, NC 28031, USA.
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Wagai JN, Rhoda D, Prier M, Trimmer MK, Clary CB, Oteri J, Okposen B, Adeniran A, Danovaro-Holliday C, Cutts F. Implementing WHO guidance on conducting and analysing vaccination coverage cluster surveys: Two examples from Nigeria. PLoS One 2021; 16:e0247415. [PMID: 33635913 PMCID: PMC7909665 DOI: 10.1371/journal.pone.0247415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software (named the Vaccination Coverage Quality Indicators—VCQI) to calculate them.–The current WHO vaccination coverage survey manual was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria–one to assess routine immunization and one to measure post-measles campaign coverage. The primary analysis for both surveys was conducted using VCQI. In this paper, we describe those surveys and highlight some of the analyses that are facilitated by the new resources. In addition to calculating coverage of each vaccine-dose by age group, VCQI analyses provide insight into several indicators of program quality such as crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and, where relevant, vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. We show that routine coverage of all vaccines is far below targets in Nigeria and especially low in northeast and northwest zones, which also have highest rates of dropout and missed opportunities for vaccination. Coverage in the 2017 measles campaign was higher and showed less geospatial variation than routine coverage. Nonetheless, substantial improvement in both routine program performance and campaign implementation will be needed to achieve disease control goals.
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Affiliation(s)
| | - Dale Rhoda
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Mary Prier
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Mary Kay Trimmer
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Caitlin B. Clary
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Bassey Okposen
- National Primary Health Care Development Agency, Abuja, Nigeria
| | | | | | - Felicity Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Huang Y, Danovaro-Holliday MC. Characterization of immunization secondary analyses using demographic and health surveys (DHS) and multiple indicator cluster surveys (MICS), 2006-2018. BMC Public Health 2021; 21:351. [PMID: 33581740 PMCID: PMC7880859 DOI: 10.1186/s12889-021-10364-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 01/31/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Infant immunization coverage worldwide has plateaued at about 85%. Using existing survey data to conduct analyses beyond estimating coverage may help immunization programmes better tailor strategies to reach un- and under-immunized children. The Demographic and Health Survey (DHS) and the Multiple Indicators Cluster Survey (MICS), routinely conducted in low and middle-income countries (LMICs), collect immunization data, yet vaccination coverage is often the only indicator reported and used. We conducted a review of published immunization-related analyses to characterize and quantify immunization secondary analyses done using DHS and MICS databases. METHODS We conducted a systematic search of the literature, of immunization-related secondary analyses from DHS or MICS published between 2006 and August 2018. We searched 15 electronic databases without language restrictions. For the articles included, relevant information was extracted and analyzed to summarize the characteristics of immunization-related secondary analyses. Results are presented following the PRISMA guidelines. RESULTS Among 1411 papers identified, 115 met our eligibility criteria; additionally, one article was supplemented by the Pan American Health Organization. The majority were published since 2012 (77.6%), and most (68.9%) had a first or corresponding author affiliated with institutions in high-income countries (as opposed to LMICs where these surveys are conducted). The median delay between survey implementation and publication of the secondary analysis was 5.4 years, with papers with authors affiliated to institutions in LMIC having a longer median publication delay (p < 0.001). Over 80% of the published analyses looked at factors associated with a specific vaccine or with full immunization. Quality proxies, such as reporting percent of immunization data from cards vs recall; occurrence and handling of missing data; whether survey analyses were weighted; and listing of potential biases or limitations of the original survey or analyses, were infrequently mentioned. CONCLUSION Our review suggests that more needs to be done to increase the increase the utilization of existing DHS and MICS datasets and improve the quality of the analyses to inform immunization programmes. This would include increasing the proportion of analyses done in LMICs, reducing the time lag between survey implementation and publication of additional analyses, and including more qualitative information about the survey in the publications to better interpret the results.
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Affiliation(s)
- Yue Huang
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland
- Present affiliation: State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - M Carolina Danovaro-Holliday
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland.
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Thomas E, Brown J. Using Feedback to Improve Accountability in Global Environmental Health and Engineering. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:90-99. [PMID: 33305578 DOI: 10.1021/acs.est.0c04115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Engineered environmental health interventions and services in low-income and resource-limited settings-such as water supply and treatment, sanitation, and cleaner household energy services-have had a less than expected record of sustainability and have sometimes not delivered on their potential to improve health. These interventions require both effectively functioning technologies as well as supporting financial, political, and human resource systems, and may depend on user behaviors as well as professionalized service delivery to reduce harmful exposures. In this perspective, we propose that the application of smarter, more actionable monitoring and decision support systems and aligned financial incentives can enhance accountability between donors, implementers, service providers, governments, and the people who are the intended beneficiaries of development programming. Made possible in part by new measurement techniques, including emerging sensor technologies, rapid impact evaluation, citizen science, and performance-based contracting, such systems have the potential to propel the development of solutions that can work over the long-term, allowing the benefits of environmental health improvements to be sustained in settings where they are most critical by improving trust and mutual accountability among stakeholders.
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Affiliation(s)
- Evan Thomas
- Mortenson Center in Global Engineering University of Colorado Boulder 4001 Discovery Drive, Suite N290 Boulder, Colorado, 80303 United States
| | - Joe Brown
- Department of Environmental Sciences and Engineering Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill, North Carolina 27599 United States
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